I read some facts that Ibuprofen is safe to take during breastfeeding as it transfers in very little amount into the breast milk. Can the milk of a mother taking motrin/advil or some other ibuprofen make a baby sleepy?


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As a general rule of thumb this concern for safe lactating (breast feeding) is of course entirely legitimate: Nonpharmacological approaches are always first-line treatment, and should also be used to complement any required drug treatment.

And the connection of ibuprofen and sleepiness may not be unfounded either: "Unusual tiredness or weakness, sleepiness or unusual drowsiness (rare), and extreme fatigue (rare)" are listed as possible side effect of ibuprofen.

This sounds scary unless one takes into account that these effects are listed as rare and:

As weak acids, NSAIDs [non-steroidal anti-inflammatory drugs] are excreted in small amounts into human breast milk with little risk for adverse effects in the suckling infant.

To get some hard numbers on this one might considers these:

Concentrations of ibuprofen in breast milk and serum were compared in 12 patients who had ingested one 400 mg tablet of ibuprofen every 6 hours over a 24-hour period for relief of post-cesarean section pain. Samples of breast milk and blood were obtained simultaneously over a 34-hour period beginning just prior to the first dose of ibuprofen. Gas-liquid chromatography assay methodology capable of detecting 1 μg/ml was used to determine concentrations of ibuprofen in serum and breast milk. Ibuprofen was present in the serum with a half-life of approximately 1.5 hours. No measurable amounts of ibuprofen were found in the samples of breast milk. The conclusion drawn is that, in lactating women who take up to 400 mg of ibuprofen every 6 hours, less than 1 mg of ibuprofen per day is excreted in breast milk.

And reach the following conclusions:

Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or antiinflammatory agent in nursing mothers.

These conclusions are in generalised form:

According to our review, AMDs [anti-migraine drugs] safe during breastfeeding are as follows: low-dose acetylsalicylic acid (ASA), ibuprofen, sumatriptan, metoprolol, propranolol, verapamil, amitriptyline, escitalopram, paroxetine, sertraline, acetaminophen, caffeine, and metoclopramide. AMDs compatible with breastfeeding but warranting caution are as follows: diclofenac, ketoprofen, naproxen, most new triptans, topiramate, valproate, venlafaxine, and cyproheptadine. Finally, high-dose ASA, atenolol, nadolol, cinnarizine, flunarizine, ergotamine, methysergide, and pizotifen are contraindicated.

But what now about the sleepy baby at hand? Babies are just sleepy in general and after feeding especially:

This is completely normal:

Breastfeeding and sleep often overlap in the early weeks, when your baby spends more time asleep than awake. Dozing off mid-feed and waking for more milk a short time later is normal for newborns.

And this period will pass:

Each baby is unique. While some mothers worry that their baby isn’t sleeping regularly enough during the early weeks and months, you may have concerns that your baby is too sleepy. Experience has shown, however, that most babies develop more of an established sleep pattern after the newborn period. Enjoy this special time with your baby.

Taken together this should read as: minimising drug intake is always a good idea, a sleepy baby is probably not a reason of big concern. If the infant seems highly unusual it is presumably still a good idea to present the case to a doctor.

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