Ibuprofen or diclofenac are the non-steroidal anti-inflammatory drugs (NSAID) of choice. Recommendations apply to full term and healthy infants.

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

This article includes the most commonly used NSAIDs; some of them are available to self-select over the counter.

Many other analgesics can also be considered in breastfeeding. See guidance on paracetamol, weak opioids, and strong opioid analgesics.


There is very limited published information on the use of NSAIDs during breastfeeding; however ibuprofen and diclofenac are the preferred choices due to their shorter half-lives and extensive use during breastfeeding in clinical practice.

All other NSAIDs have longer half-lives and should be used with caution due to the potential risk of accumulation in the infant.

Mefenamic acid should be avoided during breastfeeding because it has been associated with side effects in adults such as haemolytic anaemia.

If a cyclo-oxygenase-2 (COX-2) inhibitor is required, the preferred choice is celecoxib because negligible amounts transfer into breast milk.

Clinical considerations

When using NSAIDs in breastfeeding, try to minimise infant exposure by using the lowest effective dose for the shortest effective duration.

If clinically appropriate, topical routes of administration are usually preferred due to lower systemic absorption, leading to negligible concentrations in breast milk.

If a topical NSAID needs to be applied near or on the breast itself, precautions should be taken to avoid direct contact of the infant with treated areas.  Wash the area with warm water before breastfeeding, and reapply after feeding.  Wash hands thoroughly after application and before touching the infant.

Specific recommendations

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.


Full referencing is available on request.

Update history

  1. Link updated for paracetamol article.
  1. Published