Which cold and flu medications can I take while breastfeeding?

At some point in your breastfeeding or pumping journey it’s inevitable you’ll come down with a cold or bug—and you’ll probably consider medication to help you feel better while you take care of your baby. However, if you’re feeding your little one with breast milk, understanding which medications are generally considered safe for breastfeeding and which medications you may want to avoid is essential. 

Various amounts of medications you take can pass into your breast milk. So whether you’re nursing, pumping or both and are under the weather (so unfair, we know!), here are some key points about common cold and flu medications to consider while breastfeeding. We’ve also included a few alternatives to medications that are safe for most breastfeeding mamas.

Can I take cold and flu medications while breastfeeding?

The short answer is yes, with some exceptions. For example, if a fever, aches, pains or a headache are your symptoms, acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) can generally be taken. However, other medications, such as pseudoephedrine (Sudafed), may not be ideal.

Besides over-the-counter and prescribed medications, there are also several home remedies you can try. Here are some of the more common cold and flu medications you may consider while breastfeeding and how they might affect you, your baby and your breast milk.

Related: AAP now recommends breastfeeding beyond age 2 due to benefits for both baby and mother 

Should I breastfeed while I’m sick?

Should you keep breastfeeding while you’re sick? Also yes! Continuing to breastfeed your baby while you’re sick with a cold or virus can help pass on antibodies to your little one as protection—and also ensures that your milk supply won’t decrease. If you’re worried about passing on germs to your baby, know that by the time you start to see symptoms develop, your little one has likely already been exposed. But through the antibodies in your breast milk, you can give your baby a head start in fighting off the infection, The American Academy of Pediatrics (AAP) notes. 

What to know about fever and pain medications when breastfeeding

The Drugs and Lactation Database known as LactMed, a trusted government resource, provides insight into the safety of various drugs, medications and supplements when breastfeeding. In general, acetaminophen and ibuprofen are considered safe for nursing mamas to take.

Acetaminophen

Per LactMed, acetaminophen is ideal for pain management and treating fever in breastfeeding or pumping mothers. In addition, adverse events in infants are rare, and the amount transmitted in breast milk is significantly less than what would be a safe dose for an infant.  

Per the Infant Risk Center, acetaminophen is in the category of the safest medications to take according to Dr. Hale’s Lactation Risk categories, another method of rating the safety of medications in nursing and pumping mothers.

Ibuprofen

Per LactMed, ibuprofen is also a safe choice to alleviate pain and reduce fevers in breastfeeding or pumping mothers. Low levels are excreted in breast milk, and what is passed is below what would be considered a safe dose for a baby. 

The Infant Risk Center explains that ibuprofen is also in the category of the safest medications to take according to Dr. Hale’s risk categories.

Related: Breastfeeding while you’re sick is harder than I ever imagined

What to know about congestion medications when breastfeeding

Several medications are available to help with stuffy noses and sinus congestion. Most of these medications fall under either an antihistamine (Benadryl is an example) or decongestants (such as Sudafed). 

Antihistamines

Several antihistamines are available, with some causing more drowsiness than others. Diphenhydramine, known commonly by the brand name Benadryl, is one of the most sedating antihistamines. 

Per the Infant Risk Center, less sedating antihistamines are recommended. Examples include cetirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra.)

In contrast, antihistamines such as Benadryl can cause mothers to become too sleepy to nurse their babies safely.

Decongestants

Pseudoephedrine (Sudafed or Claritin-D) and phenylephrine (Sudafed) are over-the-counter decongestants. 

Per LactMed, use caution with decongestants. The amount of medication excreted in the breast milk likely won’t harm a breast milk-fed baby, but taking these medications can decrease a nursing mother’s milk supply. 

However, the phenylephrine often found in nasal sprays may be less likely to impact milk supply, according to LactMed.

Related: CDC warns flu vaccines in pregnant women and children are the lowest seen in several seasons

What to know about cough medications when breastfeeding

Common cough medications include guaifenesin and dextromethorphan.

Guaifenesin

An expectorant, guaifenesin helps loosen up secretions so you can cough them out. Common brand names of this medication are Mucinex and Robitussin. Per LactMed, while guaifenesin has not been well-studied in nursing mothers, it is generally considered safe.  

Dextromethorphan

LactMed describes levels of dextromethorphan, a cough suppressant, transferred to the nursing infant as low and that this medication likely will not affect a nursing infant. They recommend not combining dextromethorphan with alcohol while nursing. 

However, while the Infant Risk Center describes dextromethorphan as the safest cough suppressant for nursing or pumping mothers, they recommend observing your infant for drowsiness or poor feeding.

Codeine

This is a narcotic prescription medication used to reduce pain, and it’s sometimes used to reduce coughing. LactMed states that infants need to be monitored closely if a nursing or pumping mother is on codeine-containing products. Additionally, the Food and Drug Administration (FDA) recommends not taking codeine or medications containing codeine if breastfeeding due to the possible harmful effects on infants. 

Benzonatate

This is also a prescription medication. According to the Infant Risk Center, there is little data regarding the amount transferred through breast milk. 

While the amount transferred is likely on the low end, benzonatate can be toxic to children in low doses. For this reason, the Infant Risk Center recommends breastfeeding mothers avoid this medication when possible. 

Related: Can I take medication while breastfeeding? What every mama should know

Natural and home remedies for when you’re breastfeeding and sick

If you want to skip the meds, there are a few natural home remedies to try. 

Nasal saline irrigation 

The Infant Risk Center describes this as the safest treatment for rhinosinusitis (aka a sinus infection) in nursing mothers. Make sure to use a sterile product such as Sinus Rinse or Simply Saline. 

While rare, the Centers for Disease Control and Prevention (CDC) explains that tap water could contain various pathogens, such as the Naegleria fowleri amebae, which can cause life-threatening infections. It may be best to use cooled boiled water or distilled water if you’re opting for a neti pot. 

Zinc

If started within three days of symptom onset, Zinc may help treat cold symptoms, per a 2019 article published in American Family Physician. Zinc is often found in throat lozenges and nasal sprays. While these products have not been well studied in lactating women, LactMed explains that supplemental zinc is unlikely to harm a nursing child when used for a short time.

Honey

The Infant Risk Center explains that honey may effectively treat a cough. However, just ensure you use it for yourself and don’t give it to children younger than 1 year old. 

What to know about combo medications

Many medications, both generic and brand name, contain different types of drugs in one medication. For example, a variation of the commonly known medication DayQuil contains acetaminophen, guaifenesin, phenylephrine and dextromethorphan. 

If you were to take a dose of this version of DayQuil, it’s essential to understand it contains phenylephrine, which can impact milk supply. In addition, this medication also contains acetaminophen, known by the brand name Tylenol. Too much acetaminophen can be dangerous.

Always read the label to understand which drugs are in your medication. If you have questions, a local pharmacist or a healthcare provider are great resources to talk to. 

A note on cold and flu medication while breastfeeding

Getting sick is stressful. It can be even more stressful when you’re worried about how medications to help you feel better may impact your breast-milk fed baby. Thankfully, several options for cold and flu medications while breastfeeding are generally considered safe.

However, always read the label and reach out to a healthcare provider or pharmacist for advice if you need clarification or have questions. And if you do need to go to a provider for treatment, let them know you are breastfeeding and/or pumping. That way, they can ensure they prescribe you medications safe to take while breastfeeding.

Editor’s note: The information in this article is not intended to be a substitute for medical advice. If you have questions about which medications are safe for you and your child, reach out to your primary care provider or your child’s pediatrician for more information. 

Sources
DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the common cold. Am Fam Physician. 2019;100(5):281-289.

A version of this story was originally published on March 7, 2023. It has been updated.