Over-the-Counter Medications
IABLE
Medications Over-the-Counter Medications

Over-the-Counter Medications

Many medications are commonly available and used 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.

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

Pain Medications

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 include:

  • Acetaminophen/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 not an absolute indication to pump and dump.

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 medications for colds include:

  • 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 no absolute indication to pump and dump.

Avoid:

  • Oral and intranasal decongestants (pseudoephedrine &phenylephrine): These medications are potent in their ability to reduce milk production so alternatives are preferred.

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 medications include:

  • 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 includes medications such as hydrocortisone 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.

Heartburn

These medications are generally not an absolute indication to pump and dump.

Preferred medications include:

  1. 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.
  2. 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.
  3. 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 medications include:

  • 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 ad dump.

Preferred medications include:

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

  • 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.