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Is it safe to take cold medicine while breastfeeding?

Becoming the proprietor of a sniffly cold or a hacking cough when you have kids to look after seems like a cruel joke, but alas, viruses don’t discriminate. And if you’re breastfeeding, the situation can feel that much bleaker, since you’re probably not sure which medications you can safely take — if any.  

While some medications should be avoided entirely while breastfeeding, nursing moms aren’t completely out of relief options when they’re under the weather. In fact, some of the most beloved over-the-counter (OTC) cough and cold medicines are considered OK while nursing. 

“Even though there haven’t been any studies on guaifenesin or dextromethorphan [the main ingredients in Mucinex and Robitussin] in breastfeeding mothers, they’re thought to be safe for women who are nursing, especially for mothers of older infants,” says Dr. Brandon Smith, general academic pediatrics fellow in the Department of Pediatrics at Johns Hopkins in Baltimore. 

Even though taking Robitussin while breastfeeding is considered safe, there are medications nursing moms should avoid when they have a virus. Here, experts weigh in on the dos and don’ts of cold medicine while breastfeeding.

Which medicines are best while breastfeeding?

Natural remedies

When you feel the sniffles coming on or notice those first dreaded throat tickles, your initial line of defense shouldn’t necessarily be over-the-counter drugs. 

“Overall, there’s not a ton of great evidence out there on cough and cold medications making symptoms any better, so it’s probably best to let the cold run its course and support your body with rest and hydration, which is good for milk supply, too,” says Smith. “Other options for a troublesome cough include honey and humidification.” 

One 2010 study found that honey was equally effective in treating coughs as traditional cough syrups. 

If you’re looking to beef up your natural arsenal, Leigh Anne O’Connor, a New York City-based lactation consultant, suggests a trip to the produce aisle. 

“In addition to resting and staying hydrated, take extra vitamin C and drink tea with lemon, honey and ginger,” O’Connor says. “It’s great for soothing a sore throat and ginger can help open the sinuses. Also, keep nursing because the milk will have antibodies that will help baby avoid getting sick altogether or at least give them a less severe case.”

Cough syrup

According to Dr. Nick DeBlasio, a pediatrician and medical director of the Pediatric Primary Care Center at Cincinnati Children’s Hospital Medical Center in Cincinnati, cough suppressants such as guaifenesin and dextromethorphan (the main ingredients in Robitussin and Delsym) are safe to take while breastfeeding, as long as they’re taken as directed. 

“Guaifenesin and dextromethorphan are generally considered safe, but like many drugs, they aren’t well studied in relation to breastfeeding,” DeBlasio says. “However, the general consensus is that these medications taken in their usual doses are not considered to have an effect on the infant or the mother’s milk supply.”

Before taking cough syrup, though, be sure to read the label in its entirety since many forms include a mix of drugs that might not always be the best for a breastfeeding mom. For instance, some cough syrups may contain a decongestant, which isn’t always recommended while nursing. (More on that in a bit.)

Cough drops 

Got a nagging scratch in your throat? Go ahead and reach for a cough drop. 

“Cough drops and lozenges are generally considered safe for breastfeeding moms,” O’Connor says. 

Nasal sprays

Another great option for nursing moms who are under the weather, or who are suffering from seasonal allergies, is nasal spray. 

“Saline nasal sprays are perfectly safe for breastfeeding moms,” says Smith. “And for those with allergies, steroid nasal sprays [such as Flonase or Nasacort] are OK to use, as well.”

Acetaminophen and ibuprofen

For breastfeeding moms looking to combat headaches, fever or body aches, acetaminophen (Tylenol) and Ibuprofen (Motrin) are safe to use. 

“Ibuprofen and acetaminophen are great options for pain relief and fever control in breastfeeding mothers,” says Smith. “Studies looking at both medications in nursing mothers have shown very low levels in breast milk and rare side effects.” 

However, if you decide to take either of these painkillers, you should probably avoid taking anything in conjunction with it. 

“Look at all ingredients for OTC medications,” Smith says. “Most have more than one ingredient and usually contain acetaminophen. If you’re already taking acetaminophen by itself, you don’t want to over do it. It’s probably best and safest to take a single medication versus a product with multiple ingredients.” 

Antihistamines with loratadine and cetirizine

Loratadine and cetirizine, the main ingredients in long-lasting allergy medications such as Claritin and Zyrtec, are considered safe while breastfeeding. 

“If a nursing mother needs to take an antihistamine, I would recommend a long-acting, non-sedating one, such as loratadine (Claritin), as opposed to one that wears off quickly, such as Benadryl,” says DeBlasio. 

Which medicines should you avoid while breastfeeding?        

Decongestants with pseudoephedrine and phenylephrine

Seriously stuffed up? You may want to wait it out if you’re nursing. Decongestants, such as pseudoephedrine and phenylephrine, aren’t recommended for women who are breastfeeding. 

“Nursing moms should avoid medications that contain decongestants, such as pseudoephedrine and phenylephrine,” says DeBlasio. “These medications can decrease milk supply and can sometimes make babies fussy, as well.” 

In one study that examined the effects pseudoephedrine had on breastfed babies, 20% of nursing moms reported having babies that were “irritable” after taking a dose — a possible reason being that pseudoephedrine, which is excreted in breast milk in small amounts, affects the central nervous system, sometimes making people jittery or anxious. Another study involving eight nursing mothers found a mean 24% decrease in milk production the 24 hours following 60 mg of pseudoephedrine. Researchers found that the drug didn’t affect breast blood flow, but instead had the ability to cause a “depression of prolactin secretion.” (Prolactin is the protein that enables women to breastfeed.)

Antihistamines with diphenhydramine

While diphenhydramine, the main ingredient in Benadryl, is generally thought to be safe if used on occasion in breastfeeding moms, doctors don’t usually recommend it. In addition to it causing drowsiness and small amounts getting in breast milk, continued use can reduce milk supply.

“An occasional dose of diphenhydramine should not cause any adverse effects — specifically if it’s a single bedtime dose after the last breastfeeding,” says DeBlasio. “However, repeated, consistent use of diphenhydramine can potentially cause decreased milk production and may make some infants fussy or drowsy.” 

While the relationship between breast milk production and diphenhydramine isn’t completely clear, researchers do know that histamine is a neurotransmitter that helps stimulate prolactin. Diphenhydramine, which is an antihistamine, has been found to decrease prolactin, particularly in early postpartum women who have not yet established a solid breastfeeding routine.

Codeine

“Any cough medication with codeine should be avoided because it can cause problems, such as excess sleepiness in the baby,” says Smith.

Additionally, in rare cases, mothers may be “codeine hyper-metabolizers,” which, according to the American Academy of Pediatrics (AAP), can be associated with apnea (when a baby stops breathing), which, in one case, according to the Food and Drug Administration (FDA), resulted in the death of a breastfed baby. In some cases, codeine, when used over a period of four or more days, has been associated with the depression of the central nervous system in babies.

Aspirin

While only small amounts of low dose aspirin enter the breast milk, it shouldn’t be the pain reliever of choice for breastfeeding moms, as, in very rare cases, it has been associated with Reye’s syndrome, a disorder that causes brain and liver damage. Any connection between breastfeeding and Reye’s syndrome is likely a result of long-term, high-dose use, but across the board, experts advise nursing moms to avoid it. 

“Women who are breastfeeding should avoid aspirin,” says Smith. “It can cause severe reactions in babies and children.” 

If you’re not sure which medications are OK while breastfeeding and which ones to avoid, DeBlasio recommends consulting with your doctor and checking LactMed, which has a ton of information on how medications affect nursing moms. 

“Overall, there isn’t a lot of great data for many common medications and breastfeeding,” he says. “Because of this, it’s always important to speak with your pediatrician before taking something.”