Many breastfeeding mothers worry about what medications they can take to control symptoms of colds or flu while nursing. In general, most over-the-counter cold medications that are acceptable during pregnancy are also acceptable while breastfeeding – with one notable exception. Decongestants, designed to dry up mucous in the body, are also known anecdotally to "dry up" milk and can cause noticeable supply issues, even after just one dose.
A 2002 study in Australia of the common decongestant pseudoephedrine (commonly found in the brand drug, Sudafed, as well as many other single and combination cold medications), showed a 24% decrease in milk supply in the 24 hours after one single 60 mg dose of the drug. While this medication is generally considered "safe" in breastfeeding because little is transmitted through the milk to the baby, the effect on milk supply is often times not considered in this consideration.
In reviewing this study, I see no reason to disagree with the findings, but since the study compared each participant's placebo vs. drug period one week apart, I am wondering if hormonal cycles (reduced milk supply during menstruation, ovulation etc.) could have affected supply as well for one or both periods. I would have liked to have seem them check or control for those hormone level changes, especially as some women were nursing well past one year and were likely menstruating. I saw no mention of this.
I would like to see a much larger study of this topic that compares the effect on women in different stages of lactation. Just looking at these 8 women in the study, it appears the extended nursers' supply was just slammed – more than 50% for both of them. If that is statistically significant for that cohort, I think that's something extended nursers need to know. Those women who had established but new and robust supplies (13 and 14 weeks) hardly were affected at all. Those under 12 weeks (I am a bit bothered they were allowed to participate at all since without fully established supplies they might be endangering breastfeeding) had a slightly higher effect. These numbers were too small to draw those conclusions statistically, and this relative effect is important to understand.
It is also worth noting that due to the troubling use of pseudoephedrine in the production of methamphetamines, this active ingredient has been largely replaced in most over-the-counter decongestants by what is generally considered to be a less effective alternative. Whether these alternatives would also have a lesser effect on milk reduction would have to be studied independently.
There is also some discussion among nursing mothers whether decongestant nose sprays, used locally, have less effect on supply. While I have not seen a study on this, my own personal experience hints that this is the case. In general, if absolutely miserable from a cold, I will turn to a nose spray before taking a decongestant by mouth for this reason.
Studies aside, it is important to know that many in the professional lactation field have experienced anecdotally that decongestants do suppress milk supply. In fact, many "prescribe" it for use when women need to suddenly wean, or in the sad case of infant demise to dramatically reduce milk. In my opinion, it is best avoided when nursing. That said, there are times when it may be absolutely necessary. When this has happened to me, I have coupled it with increasing water intake (also good for congestion, as an added bonus) and use of Mother's Milk Tea or More Milk Plus to give supply a boost (for details, see my review of these products through related links at the end of this article).
Do be aware of decongestants in any combination cold medicines taken during an illness if you are nursing. Any medication that ends with "-D" is generally a decongestant (for example, Mucinex-D). Also, the word "cold" as in "cough and cold" may signal decongestant. If taking a decongestant, it may also be advisable to take the regular 4-hour dose, rather than any extended release 12-hour or 24-hour medications to be able to monitor any effect and quit the medication if needed, as well as to try to stretch out the time between doses if possible.
Full Study - Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk.
Help Protect Supply During Decongestant Use:
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