Over the Counter Medications & Prescription Cold Remedies
IABLE
Medications Over the Counter Medications & Prescription Cold Remedies

Over the Counter Medications & Prescription Cold Remedies

Many medications are available over the counter for minor ailments. This section reviews commonly used over the counter medications, preferred medications during lactation, and medications with significant risks during lactation. This section also reviews several prescription medications used for cold symptoms.

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

Pain Medications & Fever Reducers

Over the counter pain medications are generally not an absolute indication to pump and dump. For more information, see the section on Pain medications. Preferred over the counter medications for pain are included below.

Tylenol

No absolute indication to pump and dump. Typical adult doses are fine during lactation.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

  • Ibuprofen: No absolute indication to pump and dump. Typical adult doses are fine during lactation.
  • Naproxen: Naproxen is less ideal than ibuprofen because it has a longer half-life, but there is no absolute indication to pump and dump.
  • Topical pain medications (topical lidocaine, diclofenac gel, topical menthol, topical capsaicin): These medications are generally safe and not an absolute indication to pump and dump.

Over the Counter Allergy Medications

Most allergy medications are not an absolute indication to pump and dump. Older antihistamines may cause irritability in the baby or may reduce milk production, especially with regular use. For more information, please see the section on Allergy & Asthma Medications. Preferred over the counter allergy medications are discussed below.

Antihistamines

  • Non-sedating antihistamines such as loratadine, fexofenadine, or cetirizine for sneezing and itchy eyes/nose, itching and hives.
  • More potent, older antihistamines, such as diphenhydramine and chlorpheniramine, occasionally can cause irritability in the baby and may reduce milk production with regular use or in high doses. While there is no absolute indication to pump and dump, monitor milk production and the baby for irritability and weight gain if these medications are used.

Nasal cromolyn sodium

Significant amounts in breastmilk are unlikely. This is not an absolute indication to pump and dump.

Nasal corticosteroids

Significant amounts in breastmilk are unlikely. This is not an absolute indication to pump and dump.

Topical creams/ointments

This category includes medications such as hydrocortisone, anti-itch creams, allergy creams, and topic medications for pain. Significant amounts in breastmilk are unlikely. This is not an absolute indication to pump and dump.

Homeopathic cold medications

Significant amounts in breastmilk are unlikely. This is not an absolute indication to pump and dump.

Over the Counter Cold Medications

In general, most cold medications are not an absolute indication to pump and dump but decongestants are potent in their ability to decrease milk production and should be avoided when possible. Preferred over the counter cold remedies and medications to avoid are discussed in this section.

Guaifenesin

This medication is not an absolute indication to pump and dump and is used for nasal congestion and cough.

Dextromethorphan

This medication is not an absolute indication to pump and dump and is used for a cough.

Nasal saline preparations

These preparations are not an absolute indication to pump and dump and they can be used for nasal congestion.

Oxymetazoline nasal spray

This may be a lower-risk medication in decreasing milk production as compared to other decongestant nasal sprays, especially if used for 3 days or less. There is a lack of data on milk transfer, but there is low systemic absorption of inhaled oxymetazoline so infant exposure should theoretically be low. There is a case report of an infant developing irritability after maternal use of inhaled oxymetazoline according to e-lactancia. There is no absolute indication to pump and dump.

Oral and intranasal decongestants (pseudoephedrine & phenylephrine)

These medications are potent in their ability to reduce milk production so they should be avoided during lactation and alternatives are preferred.

Zinc acetate or gluconate

Zinc is a normal component of milk and typical doses of 15 mg or less found in daily vitamins do not alter zinc levels in human milk. The use of zinc supplements for cold symptoms has not been studied during lactation, but short term and limited use of these supplements during a cold is unlikely to cause significant harms to breastfed infants. There is no absolute indication to pump and dump.

Prescription Cold Medications

This section discusses prescription cough suppressants, decongestants, and other prescription cold medications.

Benzonatate/Tessalon Perles

This is a commonly prescribed cough suppressant. There is a lack of data about milk transfer of benzonatate. This medication is known to cause fatal toxicity in infants and young children and has caused poisoning in infants and adults after oral ingestion.1 Due to the lack of data and risk of  toxicity, alternative medications are preferred during lactation.

Inhaled Ipratropium/Atrovent

This is a cough suppressant. There is a lack of data on milk transfer, but maternal serum levels are negligible in available studies. There is no absolute indication to pump and dump. For more information, see the section on Asthma Medications.

Heartburn

These medications are generally not an absolute indication to pump and dump. Preferred over the counter medications for heartburn are discussed below.

Famotidine

This is a common medication used for infants, and the dose from breastmilk is expected to be lower than doses given directly to infants. This is not an absolute indication to pump and dump.

Proton Pump Inhibitors (omeprazole, lansoprazole)

These medications are given directly to infants, and doses are expected to be lower via breastmilk as compared to doses given directly to infants. This is not an absolute indication to pump and dump.

Antacids (Calcium carbonate, magnesium hydroxide, aluminum hydroxide)

These are not expected to be found in breastmilk. This is not an absolute indication to pump and dump.

Constipation

These medications are generally not an absolute indication to pump and dump. Preferred over the counter medications for constipation are discussed below.

Docusate sodium stool softener

This medication is not likely to be found in breastmilk. This is not an absolute indication to pump and dump.

Oral Magnesium (magnesium hydroxide or magnesium citrate)

This medication is not likely to be well absorbed by the infant. This is not an absolute indication to pump and dump.

Polyethylene glycol

This medication is not likely to be found in breastmilk. This is not an absolute indication to pump and dump.

Bisacodyl

This medication is not likely to be found in breastmilk. This is not an absolute indication to pump and dump.

Fiber supplements

Fiber supplements include psyllium, calcium polycarbophil, methylcellulose fiber, wheat dextrin. These medications are not likely to be found in breastmilk. There is not an absolute indication to pump and dump when taking fiber supplements.

Senna

When using “natural products”, the doses of active ingredients may vary. Monitor the infant for diarrhea or GI upset.  There  is not an absolute indication to pump and dump when taking senna products.

Diarrhea

These medications are generally not an absolute indication to pump and dump. Preferred over the counter medications for diarrhea are discussed below.

Loperamide

This is not an absolute indication to pump and dump.

Bismuth subsalicylate

Regular use can increase salicylate levels in the infant and theoretically cause metabolic acidosis. This is not an absolute indication to pump and dump when used occasionally.

Diphenoxylate (Lomotil)

There is little information on its transmission into breastmilk and no information on infant safety so alternatives are preferred, but use of this medication is not an absolute indication to pump and dump.

Motion Sickness

Infants should be monitored for sedation, but these medications are generally not an absolute indication to pump and dump. Preferred medications for motion sickness are discussed below.

Meclizine

Watch for infant sedation. It may reduce milk production with high doses or regular use. While milk production should be monitored and infants should be monitored for sedation, there is no absolute indication to pump and dump.

Dimenhydrinate

Watch for infant sedation. It may reduce milk production with high doses or regular use. While milk production should be monitored and infants should be monitored for sedation, there is no absolute indication to pump and dump.

References

(1)          McLawhorn, M. W.; Goulding, M. R.; Gill, R. K.; Michele, T. M. Analysis of Benzonatate Overdoses among Adults and Children from 1969-2010 by the United States Food and Drug Administration. Pharmacotherapy 2013, 33 (1), 38–43. https://doi.org/10.1002/phar.1153.