When you’re a new mom, you’re particularly vulnerable to colds and flus: You’re sleep deprived, grabbing junk food on the go, and if you have a preschooler bringing home daycare germs as well, you’re really in trouble. But there’s good news: It's okay to use most cold medicine while breastfeeding, even those that were off-limits during pregnancy. That’s because, while all medications reach the fetus when you’re pregnant, not all of them are passed through your breastmilk—and even those that do often only pass through in small amounts. Here’s the lowdown on what’s safe—but always speak to your doctor before taking any new medications or natural remedies.
Before you reach for anything, the first step is to figure out if you have a cold or the flu. The flu can escalate to a more serious condition, such as pneumonia, especially if you recently gave birth. That’s why it’s important to get your flu shot, and if you think you have the flu (you have a fever or feel achy or extremely fatigued), head to your doctor right away. Depending on how old your baby is and how severe your case is, your doctor may prescribe an antiviral medication, which is most effective if taken within 48 hours of your first symptoms.
If you have a cold though, you just have to wait it out. There’s nothing you can take to shorten its duration, but you can get more rest and drink plenty of fluids to help your body fight it off. Many women also find relief by managing their symptoms with over-the-counter drugs.
Acetaminophen, the medicine found in Tylenol, has been well studied in breastfeeding moms. Very small amounts of the drug pass into the breastmilk, but it’s not enough that it affects the baby, and it doesn’t affect your milk supply. As a result, it’s considered safe during breastfeeding—and it's often a go-to for controlling pain while recovering from childbirth injuries or C-sections.
Be careful about taking Tylenol while you're also taking cold and flu products like Nyquil, DayQuil, Excedrin or Robitussin, though. These medications also contain acetaminophen, so it can be easy to accidentally exceed the recommended maximum dose, which can cause serious problems like liver failure. Because these medications contain a mix of ingredients, it can be a challenge to figure out if they’re safe to use while breastfeeding. For recommendations on any particular drug, check with your healthcare provider or a pharmacist.
Antihistamines are safe for breastfeeding women, says Shawna Lamond, director and staff physician at The Alex Breastfeeding Clinic and Riley Park Lactation in Clinic in Calgary. She explains that they're often prescribed for rashes and other issues postpartum. "But any medicine that will dry up [your] will dry up the rest of you," she says. "Antihistamines decrease milk production.” If you're worried about supply, you can reach for nasal decongestants, like Otrivin, for up to three days—if you take them for longer than that, you might get rebound congestion. Or you can try a nasal steroid, like Nasacort, which is Lamond’s go-to. “I often combine that with a neti pot. Most women can get through their colds by controlling the symptoms with those two things,” she says
Cough syrups aren’t recommended while breastfeeding, says Lamond. Here's why: There are three active ingredients found in cough syrups. Pseudophedrine is one—it's effective, but will lower your milk supply so it’s not advised. The second ingredient, dextromethorphan, doesn’t dry up your milk, but it’s also not that effective. And the third, codeine, isn’t effective and can be dangerous to baby. It passes through your breastmilk and in rare cases, it can harm your baby.
Guaifenesin, an expectorant found in over-the-counter medications such as Robitussin and Mucinex, loosens mucus and makes it easier to breathe. It's OK to take while breastfeeding, and it won’t affect your supply, but expectorants generally don’t work that well, says Ellen Giesbrecht, senior medical director of the maternal newborn program at BC Women's Hospital, so they might not be worth taking.
Aspirin is best avoided while breastfeeding because, in rare cases, it may cause Reye’s Syndrome in infants with certain viral infections—that’s the same reason aspirin isn’t generally recommended for children and teenagers. If you need to take aspirin for a heart condition, your doctor may consider a low-dose treatment or alternate drug. If this applies to you or you have any concerns, speak with your doctor.
Ibuprofen, a nonsteroidal anti-inflammatory drug and the active ingredient in Advil and Motrin, is fine to take—it won’t affect the baby or your supply. Like acetaminophen, it's well studied and very low levels of the drug pass into breastmilk.
“Overall, there are concerns that the regulations aren’t as strict for supplements and other alternative products as they are for medications,” says Michelle Morais, a maternal fetal medicine specialist at McMaster University in Hamilton, Ont. That means contents of the supplement may vary from batch to batch or not match what’s on the label. In rare cases, incorrectly made versions have harmed people.
Giesbrecht says that, instead of taking over-the-counter medications, supplements or natural cures, you may want to try taking cough drops, breathing in steam, using a neti pot, or drinking tea or hot lemon water with honey, all of which have been shown to loosen mucus buildup, relieve congestion and ease coughs. “These remedies are 100 percent safe, and they work,” she says. Just be aware that ingesting large amounts of menthol through cough drops can reduce milk supply, and so can peppermint tea, so you might want to avoid overdoing these while you’re breastfeeding.
There is no data on the safety of echinacea on nursing mothers or infants, but it is considered to be compatible with breastfeeding. Just make sure that the preparation doesn’t contain other herbs and supplements that aren’t recommended. And, “it has never been proven to be effective,” points out Lamond. “But it’s safe.”
When it comes to elderberry, the harms outweigh the benefits, says Morais. “The evidence surrounding its effectiveness is limited,” she explains. “If elderberry isn’t processed properly, it can be toxic to people and cause severe nausea, vomiting and diarrhea, so it’s best to avoid it while breastfeeding.”
Ginseng is a blood thinner, so it’s not recommended for people who have certain medical conditions, such as diabetes and high blood pressure. Morais notes that, while some types of ginseng are more dangerous than others, there is limited evidence on the amount of ginseng that is passed on to breastmilk, so it’s best to generally avoid ginseng during breastfeeding.
Homeopathic preparations are now available on most pharmacy shelves, and they often look like cough syrups and other over-the-counter medications. The good news is, they’re safe to take while breastfeeding. The bad news is, homeopathic remedies don’t appear to work. Homeopathy has been well researched and has never been proven to work better than a placebo. The idea behind it—that very diluted ingredients can cure similar ailments—doesn’t hold up scientifically.
Oregano oil is promoted for its antibacterial properties but there's no research on taking it while breastfeeding. “I worry that it would decrease supply, though, because peppermint and sage both decrease supply a fair bit,” says Lamond. “But there’s no evidence around its safety or effect on milk supply.”
Vitamin C is safe when taken within the recommended daily limit of 2,000 milligrams while breastfeeding. “Your body can only absorb so much vitamin C,” explains Alix Bacon, president of the Midwives Association of British Columbia. “Beyond that, you’re peeing it out, but it could give you a wicked stomachache.” Research on whether it can help shorten the duration of a cold shows mixed results, so it’s not clear whether it works or not.
When it comes to taking zinc, there’s no risk to your baby. The maximum recommended daily limit for zinc is 40 milligrams for breastfeeding women. Like vitamin C, zinc doesn’t have strong evidence to support its use, but side effects, which may include stomach aches and a metallic taste in the mouth, are generally low.