What to take for a sore throat while breastfeeding

How do the options compare?

Each option is compared on published milk levels, the relative infant dose, what has been reported in nursing infants, any effect on milk supply, and where on the body it can be applied.

• Acetaminophen is described as a good choice for pain and fever in nursing mothers. After a 650 mg dose an infant would receive a maximum of about 2 percent of the maternal weight-adjusted dosage, and after 1 gram an average of 1.1 percent and a maximum of 1.8 percent. Adverse effects in breastfed infants appear to be rare. 1
• Ibuprofen is a preferred choice as a pain reliever or anti-inflammatory in nursing mothers because of extremely low milk levels and a short half-life. Estimated infant exposure was 0.0008 percent of the maternal weight-adjusted dosage in one study, and the mean relative infant dose was under 0.38 percent overall. 2
• Topical benzocaine has not been studied during breastfeeding but is unlikely to affect a breastfed infant when applied away from the breast. It should never be applied to the breast or nipple, because the infant may ingest it during nursing and it has been associated with severe methemoglobinemia in children under 2 years of age. 3
• Menthol and 1,8-cineol are excreted into breastmilk in small quantities. Peppermint has been used to suppress lactation and menthol can suppress milk production in laboratory and animal studies, but no clinical trials have been found demonstrating lactation suppression in humans, and it is unclear whether typical peppermint intake would be enough. 4
• Scheduled pain relief may help nursing rather than hinder it: giving acetaminophen and ibuprofen on a fixed schedule for 24 hours after vaginal delivery appears to increase the breastfeeding rate, 98 percent versus 88 percent compared with on-demand dosing. 1

Which option makes sense?

Acetaminophen and ibuprofen carry the smallest, best-quantified exposures. Benzocaine is a placement rule rather than a dose rule. Menthol is the only ingredient here with a plausible supply question attached, and it is unresolved rather than proven.

Disclosure: Pregnancy Smart offers a supplement that overlaps with one or more options above. This page describes the pregnancy evidence for each option on its own merits.