Safe Analgesics During Breastfeeding

First-Line Analgesics

The American College of Anaesthesiologists recommends paracetamol (acetaminophen) as a very safe option during breastfeeding, as the amount transferred to breast milk is significantly less than the pediatric therapeutic dose 1, 2
Ibuprofen has been used extensively for postpartum pain and during lactation with minimal transfer into breast milk, making it a safe choice 1, 2
Diclofenac is considered safe during breastfeeding, with small amounts detected in breast milk 1
Naproxen is widely used after cesarean section and is compatible with breastfeeding, despite having a longer half-life than diclofenac 1
Celecoxib is compatible with breastfeeding, with the relative dose that infants are exposed to via milk being very low 1
Ketorolac and parecoxib have low levels detected in breast milk without demonstrable adverse effects in the neonate 1

Morphine is transferred to breast milk in small amounts and is recommended as the opioid of choice if strong analgesia is required 3
Tramadol should be used with caution and the infant monitored for unusual drowsiness 1
Oxycodone has a greater risk of drowsiness in doses > 40 mg/day and should be used with caution 1

Aspirin should not be used in analgesic doses during breastfeeding, although low-dose aspirin for anti-platelet action (up to 100 mg/day) can be used if strongly indicated 1

The American College of Anaesthesiologists recommends using the lowest effective dose for the shortest time possible 1
When using tramadol, the infant should be observed for unusual drowsiness 1
With oxycodone doses > 40 mg/day, the infant should be monitored for increased risk of drowsiness 1
If repeated doses of morphine are used, the infant should be monitored for adverse effects 3
Co-sleeping with the infant should be avoided when taking sedating medications, as maternal natural responsiveness may be inhibited 1