Is ibuprofen, paracetamol, aspririn or codeine safe when breastfeeding?

It's not recommended to take aspirin³ or codeine⁴ when you are breastfeeding– and you should always check with your doctor first if you're thinking of taking any other pain-relieving medication.

Can I take paracetamol if I'm breastfeeding?

Yes¹. In fact, says Gail Johnson, a midwife educator and Honorary Fellow of the Royal College of Midwives, paracetamol has long been considered the "painkiller of choice for breastfeeding mothers".

That said, it is wise, says expert family GP Dr Philippa Kaye, to take it only for the shortest time possible and to stick carefully to the recommended dose on the packet – which is no more than 2 500mg tablets, 4 times in 24 hours (a maximum of 8 tablets in 24 hours).

The paracetamol will pass into your breastmilk but in tiny amounts. It has been used for pain relief by breastfeeding mothers for many years without any effect on their children.

Do be careful, though, to check your packet to make sure it's 'straight' paracetamol, not paracetamol combined with codeine (often called co-codamol or Solpadeine). Codeine is not suitable to take when you're breastfeeding.⁴

You should also get advice from your health visitor, midwife or doctor before taking paracetamol if your breastfeeding baby:

was born prematurely
had a low birthweight
has a medical condition

It’s worth noting, too, says Dr Philippa, that some paracetamol tablets also include caffeine (to help deliver the pain relief more effectively⁵) and it's better to avoid these ones if you can.

"If you drink coffee or tea, you are already delivering small amounts of caffeine to your baby," she says. "These small amounts are unlikely to do your baby any harm but, since paracetamol tablets without caffeine will still work, choosing those ones is an easy way to avoid extra amounts of caffeine getting into your breastmilk."

Can I take ibuprofen if I'm breastfeeding?

Yes² you can take ibuprofen tablets or use ibuprofen gel on your skin – although, says Dr Philippa, the same caution applies here as it would if you weren't breastfeeding, meaning you should check with your GP first if you have:

a stomach ulcer
asthma that gets worse if you take ibuprofen
liver or kidney problems
heart disease
Crohn's disease
a health condition that puts you at increased risk of bleeding
chickenpox or shingles

Dr Philippa also recommends that, if you do take ibuprofen, you only taken it for the shortest time possible and you stick carefully to the recommended dose on the packet – which is no more than 2 200mg tablets 3 times a day, with 6 to 8 hours in between doses (a maximum of 1200mg in 24 hours).

The ibuprofen will pass into your breastmilk but in tiny amounts that are unlikely to cause any side effects for your baby. Many breastfeeding mothers have used it for pain relief without any problems but, of course, if you notice your baby is not feeding as well as usual or you have any other concerns, you should talk to your midwife or GP.

As with paracetamol, you should get advice from your health visitor, midwife or doctor before taking ibuprofen if your breastfeeding baby:

was born prematurely
had a low birthweight
has a medical condition

It's worth knowing, too, that – very confusingly – the instructions on some ibuprofen packets and/or on some of the leaflets inside, advise you to avoid taking it while breastfeeding or to seek medical advice before you do. The NHS advice is clear that it's safe (subject to the checks we've outlined above) but do check with your pharmacist if you feel in need of extra reassurance.

Can I take aspirin if I'm breastfeeding?

No³. "It is recommended that you avoid aspirin during breastfeeding," says Dr Philippa. "This is because small amounts of aspirin may pass into your breastmilk and, although they're unlikely to cause any harm to your baby, there is a known possible link between aspirin and a rare liver disorder called Reye's syndrome."

Can I take codeine if I'm breastfeeding?

No⁴. You should not take codeine if you are breastfeeding. That's because if you do, small amounts of codeine pass into your breastmilk and can potentially cause breathing problems for your baby and/or make them drowsy.

"It may also be that this general advice about codeine⁴ changes in the future," says Dr Philippa, "as a study published in March 2023 in the British Medical Journal⁶suggest that babies of women who were prescribed an opioid after delivery were no more likely to be admitted into hospital in the first 30 days after delivery than those who were not.

"But further studies are needed and it's important that, for now, that we all follow the current advice."

What about other painkillers?

"If you’re thinking of taking any medication other than paracetamol or ibuprofen while breastfeeding," says Dr Philippa, "you really should ask your doctor about it first.

"This doesn’t mean that you should just put up with being in pain, of course: many women with small babies will require more pain relief than paracetamol, especially if they have had a Caesarean section. If this is the case for you, your hospital doctor, your midwife or you GP are best placed to decide what's best for you to take.

"You may find, for example, that your doctor prescribes you an opioid medication such as dihydrocodeine. Now, we've seen (above) that codeine is not recommended during breastfeeding due to concerns that small amounts of it can pass into your milk and make your baby drowsy. Dihydrocodeine is related to codeine but, in certain circumstances, it can be prescribed by a doctor to a breastfeeding mother at the lowest effective dose."

References:

^{1. Pregnancy, breastfeeding and fertility while taking paracetamol for adults. NHS Online}^{2. Pregnancy, breastfeeding and fertility while taking ibuprofen. NHS Online}^{3. Pregnancy, breastfeeding and fertility while taking low-dose aspirin. NHS Online}^{4. Pregnancy, breastfeeding and fertility while taking codeine. NHS Online}^{5. Caffeine as an analgesis adjuvant for acute pain in adults. Derry CJ et al. Cochrane, 11 December 2014}^{6. Maternal opioid treatment after delivery and risk of adverse infant outcomes: population based cohort study. Zipursky et al. BMJ 2023;380:e074005 (Published 15 March 2023)}

About our expert GP Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.

Pic: Getty Images

Helen BrownHead of Content Delivery

Helen is author of the classic advice book Parenting for Dummies and a mum of 3. Before joining MadeForMums, she was Head of Community at Mumsnet and also the Consumer Editor of Mother & Baby.