Muscle Relaxants in Lactating Mothers

Safety of Neuromuscular Blockers

The American College of Anesthesiologists recommends that neuromuscular blocking agents, such as suxamethonium, rocuronium, vecuronium, and atracurium, are safe and compatible with breastfeeding, with no interruption of nursing required 1
These agents have poor oral bioavailability and do not pose risks to breastfed infants even when used during operative procedures, according to the American Society of Anesthesiologists 1
Neostigmine (reversal agent) and sugammadex are also compatible with breastfeeding, as stated by the American College of Anesthesiologists 1
Breastfeeding may resume as soon as the mother has recovered sufficiently from anesthesia, with no waiting period required, as recommended by the American Society of Anesthesiologists 1

The American Academy of Pediatrics recommends that mothers taking any sedating muscle relaxant should never co-sleep with their infant, as natural maternal responsiveness may be inhibited, with a strength of evidence rated as high 1, 2
Extra caution is required for infants less than 6 weeks of age due to immature hepatic and renal function, as advised by the American Academy of Pediatrics 2
Preterm infants have the highest medication sensitivity and require heightened vigilance, according to the American Academy of Pediatrics 2
Monitor infants for unusual drowsiness, poor feeding, or decreased responsiveness when mothers use any sedating medication, as recommended by the American College of Anesthesiologists 1

The American College of Obstetricians and Gynecologists recommends that multimodal analgesia with non-opioid drugs should be the first-line approach for musculoskeletal pain in lactating mothers, with a strength of evidence rated as high 1, 2
Paracetamol and ibuprofen are the safest first-line options, compatible with immediate breastfeeding without any waiting period, as stated by the American Academy of Pediatrics 1, 2, 3
Other NSAIDs including diclofenac, naproxen, celecoxib, ketorolac, and parecoxib are also safe alternatives, according to the American College of Rheumatology 1, 4
If opioid analgesia is required for severe pain, morphine is the preferred choice at the lowest effective dose for the shortest duration, as recommended by the American Pain Society 1, 2, 4