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.

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.

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

• 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.

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.

• 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.

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

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

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.

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

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.

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

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

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

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.

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

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.

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

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.

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.

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

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.

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.

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

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

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

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

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

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

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.

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.

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

This is not an absolute indication to pump and dump.

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.

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.

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.

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.

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.