Cough and cold remedies and Breastfeeding - The Breastfeeding Network

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This factsheet is intended to provide access to relevant evidence-based information. The national guidelines, research, data, pharmacokinetic properties and links shared are taken from various reference sources, they were checked at the time of publication for appropriateness and were in date. These are provided where we believe the information may be useful but we do not take any responsibility for their content. This factsheet is provided to empower users to make an informed decision about their treatment; but it does not constitute medical advice and cannot replace medical assessment, diagnosis, treatment or follow up from appropriately trained healthcare professionals with relevant competence.

The Breastfeeding Network factsheets will be reviewed on an ongoing basis, usually within three years or sooner where major clinical updates or evidence are published. No responsibility can be taken by the Breastfeeding Network or contributing authors for the way in which the information is used.

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Optimal treatment choices:
Paracetamol
Ibuprofen
Steam Inhalation
Decongestant nasal spray
Anaesthetic throat spray or lozenges

Summary

You can continue to breastfeed when you have a cough, cold, the flu or COVID-19. Your child will not catch the infection from your breastmilk. Your milk will contain antibodies to the infection, which may protect your child. You can reduce the risk of passing the infection to your child though good hygiene and avoiding coughing or sneezing on them. Several expert sources say that the benefits of breastfeeding outweigh the risk of your child catching these viruses (CDC).

You can take paracetamol and ibuprofen whilst breastfeeding, at the normal adult doses. This, along with plenty of fluids and rest, may be the most effective remedy. Avoid products containing codeine and aspirin.

Oral decongestants are not recommended when you are breastfeeding as they can reduce your milk supply with just one or two doses.  

There are many combination cold & flu products available, containing multiple medications. Each ingredient should be checked separately to see if you can take it when breastfeeding.

You can also use decongestant nasal sprays, steam inhalation and throat sprays or lozenges to relieve your symptoms.

Pain relief and to reduce a fever

Paracetamol: You can take paracetamol at the normal adult dose as described on the patient information leaflet. Some paracetamol-containing medications also contain caffeine in varying amounts. The NHS suggests that you should not have more than 200mg of caffeine per day whilst breastfeeding, including from drinks, as it could make your baby restless or keep them awake, so bear this in mind when choosing which medicine to take. See the NHS page on breastfeeding and diet for more information.

Ibuprofen: You can take ibuprofen at the normal adult dose as described on the patient information leaflet.

You can take paracetamol and ibuprofen together if needed while breastfeeding.

If your breastfed child is also taking paracetamol or ibuprofen (e.g., Calpol®, Nurofen for children®), the additional amount of medication in your breastmilk will be very small. Both you and your child can take these medications at the same time at normal doses. 

Aspirin: Products containing aspirin for pain relief are not recommended when you are breastfeeding because of the risk of Reye’s Syndrome. If you take a single dose of aspirin by mistake, you can continue breastfeeding as the risk is very small, but you should not take any further doses. See our factsheet on pain relief more information.

Codeine: You should not take codeine when you are breastfeeding. If you take a single dose of codeine by mistake, you can continue breastfeeding as normal as long as your child is full term and otherwise well, as the risk is very small, but you should not take any further doses. See our factsheets on pain relief and codeine for more information.

Combined Products

Many combined products contain paracetamol or ibuprofen with other ingredients. Always check the individual ingredients and take care not to exceed the maximum daily doses. Most combined products contain ingredients that are not recommended when breastfeeding, such as decongestants, aspirin or codeine (e.g. Sudafed®, Lemsip®, co-codamol or Anadin Extra®). Always read the label carefully before using.

Antihistamines: Antihistamines such as diphenhydramine (Nytol Original®) or promethazine (Phenergan®, Avomine®, Sominex®) are sometimes included in cough and cold remedies (e.g. Night Nurse®) as they can dry up a runny nose and aid sleep by making you drowsy. You can take these whilst breastfeeding, although the NHS recommends that you use them only occasionally or for short periods. They may also make your baby irritable, drowsy or feed less frequently. Non-drowsy options are available if you need an antihistamine. See our factsheet on antihistamines for more information. It is possible that antihistamines could also reduce your milk supply if used repeatedly, especially in the first few weeks after your baby is born, although the evidence for this is limited.

Medicines that make you drowsy can make bed-sharing less safe. Baby Sleep Info Source (BASIS) has more information on sleep and safety. They recommend that you do not share your bed with your baby after you have taken medication that makes you sleepy.

Decongestants and steam inhalations

Decongestant tablets, powders and drinks (e.g. Lemsip®. Sudafed®, Beechams all-in-one®, Sinutab®, drug names include pseudoephedrine and phenylephrine) are not recommended when you are breastfeeding because they may reduce your breastmilk supply. For more information, see our factsheet on decongestants.

Nasal decongestant sprays or drops (e.g. Otrivine®, Sudafed®) act directly on your nasal passages to relieve congestion. Very little will be absorbed into your body and pass into your breastmilk, so you can use them when you are breastfeeding, as an alternative to decongestant tablets or powders.

Steam inhalations can help to relieve nasal congestion. You may find adding menthol and eucalyptus (e.g. Vicks VapoRub®) helpful because of the cooling effect on your nasal passages. You should take care with bowls of very hot water if your child is nearby.

Expectorant cough mixtures

Guaifenesin is used to relieve a chesty cough. There is very little data on the safety of guaifenesin when you are breastfeeding but the levels in your milk at normal doses are unlikely to cause harm to your child, especially if they are over 2 months of age. You can visit the NHS website for more information on treating a chesty cough.

Cough Linctus/Syrup

A linctus is a syrupy solution (which may be sugar free) used to soothe coughs. You should check the active ingredients individually. Many are based around glycerine and lemon, which you can take safely during breastfeeding. 

Products containing dextromethorphan will calm a dry cough. You can take these whilst breastfeeding, but you should avoid them if there is any phlegm on your chest. Suppressing a chesty cough could cause a chest infection, particularly if you are asthmatic.

Bronchostop cough syrups and pastilles contain thyme herb extract. There is no data on the safety of thyme herb extract when breastfeeding, and some sources suggest that it may reduce your milk supply, so these products are not recommended whilst you are breastfeeding.

Some medicines for dry cough, and other cough and cold combined medicines, used to contain pholcodine. Pholcodine was withdrawn from the UK market in March 2023, due to the possible risk of it causing an allergic reaction if you go on to have a general anaesthetic. If you have any medicines containing pholcodine that were purchased before March 2023, you should not use these and instead return them to a pharmacy for safe disposal.

Anaesthetic sprays, lozenges or pastilles to soothe coughs and sore throats

You can use lozenges, pastilles and throat sprays (e.g. Strepsils®, Ultra-Chloraseptic throat spray®, Difflam®) when you are breastfeeding, to relieve your symptoms. There is very little data on whether these products affect breastfed infants, but they have been used extensively without reports of problems. The ingredients are not expected to pass into your breastmilk in large enough amounts to affect your child. See our factsheet on sore throats for more information.

Vapour rubs

It is best not to apply adult vapour rubs (e.g., Vicks VapoRub®) to your chest whilst breastfeeding as the smell can be quite strong for your child, could cause breathing difficulties, and may get into their eyes. You can use products intended for children, (e.g., Calpol vapour plug® and Snufflebabe® vapour rub) on yourself, as per manufacturer instructions but again taking care that nothing can be rubbed into your child’s eyes.

Alternative remedies and herbs

Some people like to take supplements or alternative remedies to increase immunity and help the body to fight symptoms of coughs and colds. You can take vitamins and minerals at the daily recommended dietary allowance. Always read the label.

Supplements sold to help the immune system often include zinc and selenium which you can take in doses not exceeding the recommended dietary allowance.

You can take vitamin C at usual doses of 50-200mg daily. High doses of vitamin C under 1000mg daily are unlikely to cause side effects.

A daily dose of Vitamin D at 10micrograms/ 400 units is recommended whilst you are breastfeeding. Doses of up to 4000 units per day may be recommended by your doctor if you are deficient in vitamin D.

In general, herbal supplements are not recommended when breastfeeding as there is not enough information on whether they pass into breastmilk and what effect they might have. See our factsheet on herbal remedies for more information. There is no evidence that echinacea is harmful whilst breastfeeding, but no studies have been done that show it is safe either, so it should be used with caution. The evidence for echinacea working to prevent or treat a cold is limited (Karsch‐Völk et al., 2014).

If you have any questions or concerns about using any of these products whilst breastfeeding, please speak to your doctor, pharmacist, or contact the Drugs in Breastmilk service.