Best cold medicine while breastfeeding

How do the options compare?

Each ingredient is compared on how much reaches breast milk, what it does to milk production, what has been reported in nursing infants, and how long the exposure lasts.

• A single 60 mg dose of pseudoephedrine was followed by a mean 24 percent decrease in milk production over the next 24 hours in eight nursing mothers, and the breastfed infant receives about 4.3 percent of the maternal weight-adjusted dose. 1
• Acetaminophen shows up in breast milk at low levels, and negative effects in newborns exposed through milk are rare. 2
• Guaifenesin has not been studied during breastfeeding and it is unknown whether it enters milk, but used as directed it is not expected to cause side effects in a nursing child. Any product chosen should be alcohol-free. 3
• Dextromethorphan reaches milk in small amounts when used as directed for cough, and short-term over-the-counter use is not expected to cause problems for most breastfed infants. Some liquid versions contain alcohol, so the ingredient panel is worth reading. 4
• Oxymetazoline nasal spray works by narrowing blood vessels where it is applied, and very little is thought to be absorbed into the body when used as directed in the nose. 5

Which option makes sense?

Choose by single ingredient. Acetaminophen and an oxymetazoline nasal spray carry the smallest exposure, guaifenesin and dextromethorphan are reasonable short-term, and oral pseudoephedrine is the one ingredient with a measured hit to milk production.

Disclosure: Pregnancy Smart makes supplements that overlap with some options above. This comparison describes the evidence, not our own product; where our formulation is relevant it is named.