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UK
Drugs in Lactation Advisory Service
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Non-Steroidal
Anti-Inflammatories
- Individual
maternal and infant situations must be taken into account before any
drug is prescribed for the mother.
- In
general, all drugs should be avoided in premature or low birth weight
infants, or in those who have any underlying conditions.
- If
a drug is prescribed, it should be at the lowest practical dose and
for the shortest time.
|
Drugs
|
Suitability
for use in lactation
|
Comments
|
|
Levels
in milk generally low as NSAIDs are weak acids and extensively bound
to plasma proteins. Short-acting agents and those without active
metabolites preferred, especially in neonates.
|
| COX-1
inhibitors |
Azapropazone |
No
|
Safety
concerns. CSM restrictions apply |
| Diclofenac |
Yes
|
Low
levels in milk |
| Diflunisal |
?
|
Long
half life |
| Flurbiprofen |
Yes
|
Low
levels in milk |
| Ibuprofen |
Yes
|
Negligible
levels in milk |
| Ketorolac |
Yes
|
Low
levels in milk |
| Mefenamic
acid |
No
|
Prefer
NSAID with more favourable ADR profile |
| Naproxen |
?
|
Single
case of prolonged bleeding time, haemorrhage and acute anaemia seen
in a neonate. Longer half-life. Best avoided in neonates |
| Piroxicam |
?
|
Levels
in milk low. Very long-half suggests unsuitability for neonatal exposure
via breast milk |
| COX-2
inhibitors |
Celecoxib |
?
|
No
clinical data available. |
| Rofecoxib |
?
|
No
clinical data available. |
| Topical
NSAIDs |
e.g.
Ibuprofen, diclofenac |
Yes
|
Negligible
passage into milk expected |
Drugs
classified with '?' should be used with caution and only after an assessment
of benefit to the mother versus risk, real or potential, to the infant.
These drugs either have insufficient clinical data on their use in lactation
to regard as absolutely safe or they have had minor, reversible side effects
reported in a breast-fed infant.
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