What can I take for a cold or flu?

From LLL in VA/WV References

Coming down with a cold or flu when you’re nursing a baby brings up some questions — Is it okay to take the medicines I usually take for a cold? Should I nurse my baby when I’m sick? What are safe cold remedies that work?

Resources

Here are some good places to start:

If you're in the US, a great resource for questions about medication while breastfeeding is the InfantRisk Center at Texas Tech University.

InfantRisk Center
(806) 352-2519
Monday–Friday
8:00 am–5:00 pm Central Time

InfantRisk was established by Dr. Thomas Hale, a pharmacologist who is the leading expert in the use of medications during lactation. The counselors there will consider the drug you've been prescribed, the dosage, how old your baby is, what his or her nursing pattern is like, and give you information that's specific to your situation.

They can also provide information about non-prescription drugs, herbal products, vaccines, chemicals, and other substances.

Keep Nursing

The first thing to do when you're sick is to keep nursing your baby as often as you can. The antibodies in your milk will help prime your baby’s immune system to fight off the virus. Some moms experience a dip in milk supply when they’re sick; frequent nursing can help prevent the dip or else help your supply rebound quickly as you recover.

Home Remedies

There are a number of home remedies that might help you feel better without having to take medicine:

  • Lots of fluids! Water, juice, clear broth, or warm lemon water with honey can help loosen congestion and prevent dehydration. Avoid beverages with a lot of caffeine, and be careful with herbal teas—some teas might contain herbs that should be avoided while breastfeeding.
  • Salt water gargle - ¼ to ½ teaspoon salt dissolved in an 8-ounce glass of warm water can temporarily relieve a sore or scratchy throat.
  • Saline nasal irrigation - Over-the-counter saline nasal drops and sprays can help clear out stuffiness and congestion. Nasal rinsing can also be done with squeeze bulb or neti pot. Note: If you use a neti pot, remember to use distilled water. Tap water should not be used unless it's boiled and cooled first. [1]
  • Humidity - Dry air can make stuffy noses and scratchy throats feel worse. A humidifier can counteract the dry air in your home, but be sure to keep the humidifier clean. A steamy shower or a pot of water boiled on the stove are low-tech ways to temporarily relieve the dryness and breathe easier.

Over-the-Counter Cold Medicines

If you still feel miserable, you might consider an over-the-counter cold medicine. Many are compatible with breastfeeding, but check the ingredients carefully, keeping in mind that

  • It’s better not to take medication you don’t need, so avoid products that include medicines for symptoms you don’t have. For example, if you have a headache and congestion, but no cough, look for a product that does not include a cough suppressant.
  • Pseudoephedrine is known to suppress milk production, especially in moms of older babies. Most OTC cold medicines now contain a different decongestant—phenylephrine. There are concerns that phenylephrine may reduce milk supply also, but so far we don’t have any evidence that it does.
  • Ibuprofen and acetaminophen are the preferred pain relievers for breastfeeding moms.

Most over-the-counter cold medicines are a combination of medications. They usually include a pain reliever and one or more of the following:

Look for ingredients that match your symptoms. For example, if you have a headache and congestion, but no cough, it would be best to choose a medicine that does not include a cough suppressant.

Pain Relievers

Ibuprofen is usually the preferred pain reliever during breastfeeding. However, your circumstances may be different, so please check with your health care provider.

Acetaminophen

InfantRisk category: L1 - Extensive Data-Compatible

Acetaminophen, also known as paracetamol or the brand name Tylenol, is the most common pain reliever in OTC cold medicines.

According to LactMed, acetaminophen is a good choice for pain relief and fever reduction for breastfeeding mothers.

The amount of acetaminophen that transfers into breastmilk is probably too low to affect a breastfed baby. Babies are often given acetaminophen directly, in much higher amounts than they would get through breastmilk.

Aspirin

InfantRisk category: L2 - Limited Data-Probably Compatible

A few cold medicines, such as Alka-Seltzer, may contain aspirin. Excedrin products usually contain aspirin.

Only small amounts of aspirin transfer into breastmilk, and there have not been many reports of harmful effects. Because it is associated with Reye Syndrome, however, most authorities recommend avoiding aspirin during breastfeeding. [2] [3]

If you need to use aspirin, you may be able to prevent exposure to your baby by waiting 2 hours after taking it before breastfeeding again. [4]

To avoid any risk of Reye Syndrome, don't use aspirin if your baby has a viral illness.

Ibuprofen

InfantRisk category: L1 - Extensive Data-Compatible

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief. It's sold under the brand names Advil and Motrin, and is also commonly used in combination cold medicines.

The amount of ibuprofen that transfers into breastmilk is very low.

Ibuprofen is considered the best choice for pain relief during breastfeeding. [5] [6]

Naproxen

InfantRisk category: L3 - Limited Data-Probably Compatible

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief. It's also known by the names Aleve and Naprosyn.

The amount of naproxen transferred to milk is low and harmful effects are not common in breastfed babies. But because it stays in the body for a long time, and there have been rare but serious side effects, breastfeeding mothers should be cautious about using naproxen. [7]

InfantRisk says naproxen can be used during breastfeeding for short periods or only occasionally [8], but check with your doctor first.

Decongestants

Pseudoephedrine is known to suppress milk production, especially in moms of older babies. Most OTC cold medicines now contain phenylephrine instead of pseudoephedrine. There are concerns that phenylephrine may reduce milk supply also, but so far we don’t have any evidence that it does.

Decongestant nasal sprays or saline nasal irrigation may be better choices for treating congestion while you're breastfeeding.

Pseudoephedrine

InfantRisk category: L3 - Limited Data-Probably Compatible

Pseudoephedrine is a decongestant, best known by the brand name Sudafed. It's used in some combination cold and allergy medicines, although many products have replaced it with another decongestant, phenylephrine.

Pseudoephedrine is also a stimulant. It has the potential to cause some serious side effects, especially when taken in combination with other stimulants like caffeine. Because of this, and because it's used in the manufacture of methamphetamine, many countries now require products containing pseudoephedrine to be kept behind the pharmacy counter. In some countries, it can only be obtained with a prescription.

Only small amounts transfer into breastmilk, but caution is recommended because pseudoephedrine is known to reduce milk production, especially in moms of older babies (older than 8 months). [9]

Irritability and agitation have occasionally been reported in babies whose mothers took pseudoephedrine. [10]

Phenylephrine

InfantRisk category: L3 - No Data-Probably Compatible

Phenylephrine is the most common decongestant in combination cold medicines. Some studies have suggested that it may not be effective for nasal congestion, however. [11], [12]

Although there is no data on the transfer of phenylephrine into breastmilk, a breastfed baby is unlikely to absorb very much of the medicine even if it is present in breastmilk. [13]

There is some concern that phenylephrine might reduce milk production in the same way that pseudoephedrine can. [14] No studies have been done, though.

The use of phenylephrine in nasal sprays or eye drops is unlikely to harm milk production. [15]

Oxymetazoline

InfantRisk category: L3 - No Data-Probably Compatible

Oxymetazoline is a decongestant that is commonly used as a nasal spray. It's the main ingredient in nasal sprays like Afrin and Vicks Sinex.

While there aren't any good studies on the use of oxymetazoline during breastfeeding, it probably wouldn't affect a breastfed baby because it's administered directly into the nose and is poorly absorbed.

Oxymetazoline may be a better choice than an oral decongestant during breastfeeding, because little of the medication is likely to reach the baby, and it's unlikely to affect milk production. [16]

Don't use oxymetazoline for longer than 3 days. If you use the nasal spray for too long, the congestion can come back even worse. [17]

Antihistamines

InfantRisk generally recommends newer, non-sedating antihistamines—like Allegra, Claritin, or Zyrtec—for breastfeeding mothers.

Cetirizine

InfantRisk category: L2 - Limited Data-Probably Compatible

Cetirizine is an antihistamine, also known by the trade name Zyrtec.

Studies in animals suggest that only 3% of the mother's dose is transferred into breastmilk. [18]

Cetirizine is less likely to cause drowsiness than some other antihistamines.

According to LactMed, the British Society for Allergy and Clinical Immunology recommends cetirizine at its lowest dose as the preferred antihistamine during breastfeeding. [19]

Chlorpheniramine

InfantRisk category: L3 - Limited Data-Probably Compatible

Chlorpheniramine is an antihistamine that may be present in a few combination cold or allergy medicines. It's sold on its own as Chlor-Trimeton, and it's also an ingredient in Advil Allergy Sinus products.

Since it causes extreme drowsiness, it's not the first choice of antihistamines for breastfeeding mothers. InfantRisk recommends non-sedating antihistamines during breastfeeding.

Diphenhydramine

InfantRisk category: L2 - Limited Data-Probably Compatible

Diphenhydramine is a common antihistamine that is present in many combination cold and allergy medicines. It's best known under the trade name Benadryl. It's also used in a number of non-allergy products like the "nighttime" versions of cold medicines or pain relievers.

The amount that transfers into breastmilk is low, but diphenhydramine can cause sleepiness in both the mother and the breastfed baby. InfantRisk recommends using a non-sedating antihistamine, if possible.

There are anecdotal reports that diphenhydramine reduces milk production, but there's no research that shows this to be the case.

Doxylamine

InfantRisk category: L3 - No Data-Probably Compatible

Doxylamine is an antihistamine that is used as a sleep aid. It's best known under the trade name Unisom. It's also a common ingredient in nighttime cold medicines like Vicks Nyquil and Tylenol Cold nighttime formulas.

There are no studies on the transfer of doxylamine into breastmilk, but there have been a few reports of extreme sleepiness or breathing problems in breastfed babies, so caution is recommended, especially if you have newborn or premature baby. [20]

Fexofenadine

InfantRisk category: L2 - Limited Data-Probably Compatible

Fexofenadine is an antihistamine best known by the trade name Allegra.

Only very small amounts transfer into breastmilk, and it doesn't cause drowsiness, so it's not expected to cause any harmful effects in breastfed babies. [21]

Loratadine

InfantRisk category: L1 - Limited Data-Compatible

Loratadine is an antihistamine best known by the trade name Claritin.

Only very small amounts transfer into breastmilk, and it is unlikely to cause drowsiness, so loratadine is not expected to have any harmful effects in breastfed babies. [22]

Sources

Cough Medicines

Dextromethorphan

InfantRisk category: L1 - No Data-Compatible

Dextromethorphan is a common cough suppressant. It's in most OTC cold medicines that are marketed for cough.

There's no data on its transfer into breastmilk, but it's unlikely that enough would transfer to affect a breastfed baby.

InfantRisk recommends keeping an eye out for sleepiness or poor feeding in the baby, though, just in case. [23]

Guaifenesin

InfantRisk category: L3 - No Data-Probably Compatible

Guaifenesin is an expectorant meant to thin and loosen mucus in the respiratory tract; it's not a cough suppressant. It's an ingredient in many combination cold and cough medicines, and is also sold on its own under the trade name Mucinex.

There is some question about whether guaifenesin is effective in the treatment of cough. Research results have been mixed. [24]

There's no data on the transfer of guaifenesin into breastmilk, but no side effects have been reported in breastfed babies.

According to MommyMeds, drinking lots of water can thin respiratory secretions just as well as guaifenesin. [25]

Throat Lozenges/Sprays

The medicines in most lozenges and cough drops probably don't get into breastmilk in high enough amounts to cause problems for a breastfed baby.

InfantRisk recommends avoiding phenol, which is the medication in some throat sprays, unless there are no better options for the mom. Benzocaine and menthol are probably safe to use during breastfeeding.

Different products from the same company may use different medicines, so it's always a good idea to check the label! For example, Chloraseptic sore throat sprays contain phenol, but Chloraseptic lozenges contain benzocaine and/or menthol.

Benzocaine

InfantRisk category: L2 - No Data-Probably Compatible

Benzocaine is a topical anesthetic used in some throat sprays and lozenges, such as Chloraseptic Sore Throat Lozenges and Cepacol Sore Throat Oral Pain Reliever lozenges.

When used for sore throat pain, benzocaine is unlikely to be absorbed into the mother's system in high enough levels to cause side effects in a breastfed baby. [26]

Dyclonine

InfantRisk category: L3 - No Data-Probably Compatible

Dyclonine is a local anesthetic that is used in Sucrets cough and sore throat lozenges.

There's no data on its transfer into breastmilk. Topical anesthetics usually do transfer into breastmilk, but not at concentrations that could cause side effects in a breastfed baby.

Menthol

InfantRisk category: L3 - No Data-Probably Compatible

Menthol is a common ingredient in cough drops and sore throat lozenges.

Only very small amounts transfer into breastmilk.

There are no high quality studies of menthol in breastfeeding mothers, but it's unlikely that it would cause side effects in breastfed babies.

Phenol

InfantRisk category: L4 - No Data-Possibly Hazardous

Phenol is a topical anesthetic and antiseptic used in some sore throat sprays, particularly Chloraseptic sprays.

There's no data on the transfer of phenol into breastmilk.

Phenol can cause burns if it's too concentrated.

Dietary Supplements and Herbal Remedies

The experts at InfantRisk generally recommend that breastfeeding mothers avoid taking dietary supplements and herbal medicines. All drugs, whether pharmaceutical or herbal, should only be used in situations where the benefit to the mother and family clearly exceeds the risk to the baby. Because there is little data on either the safety or effectiveness of most herbal drugs, it is difficult to establish their relative benefits and risks.

Herbal supplements are not regulated for safety, quality, or effectiveness, and for most herbs, there is little or no data on how their chemical components transfer to breast milk.

Recent studies suggest that many herbal products are poorly controlled for quality and may contain other plant species, contaminants, or fillers that are not listed on the label.

Colloidal Silver

InfantRisk category: L4 - No Data-Possibly Hazardous

Colloidal silver consists of particles of silver suspended in a liquid. As a dietary supplement, it's sometimes promoted as a way to prevent colds and flu, though there's no evidence that it can treat or prevent any medical condition, or that it has any beneficial effects.

While not extremely toxic, silver can deposit in the organs and build up in the body. If too much builds up, it can cause a dark gray or bluish discoloration of the skin, gums, and the whites of the eyes. Called argyria, this discoloration is irreversible once it occurs. [27]

Animal studies suggest that exposure to silver during pregnancy could cause birth defects. [28]

Echinacea

Echinacea is an herb that is commonly used for the prevention or treatment of colds. While research has had mixed results, the most recent reviews suggest that echinacea is not effective for either preventing or shortening colds. [29]

Safety:
InfantRisk category: L3 - No Data-Probably Compatible
General Use: LIKELY SAFE for most adults when taken for up to 10 days.
Breastfeeding: SAFETY UNKNOWN during breastfeeding. The chemical components of echinacea transfer into breastmilk at about the same levels that are in the mother's bloodstream. [30]
Pregnancy: POSSIBLY SAFE during pregnancy.
Possible Side Effects:
Side effects that have been reported include: fever, nausea, vomiting, dry mouth or an unpleasant taste in the mouth, stomach pain, diarrhea, sore throat, headache, dizziness, insomnia, and joint and muscle aches.
May cause allergic reactions in people who are allergic to ragweed, chrysanthemums, marigolds, or daisies.

Elderberry Syrup

InfantRisk category: L4 - No Data-Possibly Hazardous [31]

Elderberry syrup is a popular herbal remedy for cold and flu symptoms. A commercial formula is sold under the trade name Sambucol.

Elderberry leaves, stems, and unripe fruit contain cyanide components and can cause serious toxicity. Cooked, ripe berries are probably safe to use. [32]

InfantRisk recommends using only high quality products, and only for short periods of time.

Sources