Is Diclofenac compatible with breastfeeding? Do we have alternatives for Diclofenac?

Diclofenac

March 23, 2018 (Very Low Risk)

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID).

Its pharmacokinetic data (high percentage of protein binding and short half-life) explain the zero or miniscule transfer into breastmilk observed.

The drug is excreted in milk in insignificant or undetectable quantities (AEMPS 2017, Sandoz 2017, Hale 2017 p.277, Hutchinson 2013, Worthington 2013, ABM 2012, Østensen 2007, Sioufi 1982).

No adverse effects have been detected in breastfed babies whose mothers were taking it (Yefet 2017, Davanzo 2014, Hutchinson 2013, Hirose 1996).

For all these reasons it is considered compatible with breastfeeding (Yefet 2017, Davanzo 2014, Hutchinson 2013, Amir 2011, Lee 1993, Brooks 1990, Goldsmith 1989, Needs 1985).

Most non-steroidal anti-inflammatories can increase jaundice, so it is preferable to avoid them during the neonatal period in mothers of jaundiced infants. (Janssen 2000).

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Diclofenac Diethylamine
  • Diclofenac Epolamine
  • Diclofenac Potassium
  • Diclofenac Sodium

Writings

  • Δικλοφαινάκη (Greek)
  • ديكلوفيناك (Arabic)
  • Диклофенак (Cyrillic)
  • 双氯芬酸 (Chinese)
  • ジクロフェナク (Japanese)
  • Diclofénac (French)
  • C14H10Cl2NNaO2 (Molecular formula)
  • Sodium [2-(2,6-dichloroanilino)phenyl]acetate (Chemical name)
  • D11AX18 (ATC Code/s)
  • M01AB05, M02AA15 (ATC Code/s)
  • S01BC03 (ATC Code/s)

Drug trade names

References

  1. AEMPS. Diclofenaco Ficha técnica. 2017 Full text (in our servers)
  2. Sandoz. Diclofenac. Data Sheet. 2017 Full text (in our servers)
  3. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  4. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014Abstract
  5. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013Abstract Full text (in our servers)
  6. Hutchinson S, Marmura MJ, Calhoun A, Lucas S, Silberstein S, Peterlin BL. Use of common migraine treatments in breast-feeding women: a summary of recommendations. Headache. 2013Abstract Full text (link to original source) Full text (in our servers)
  7. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011Abstract Full text (link to original source) Full text (in our servers)
  8. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007Abstract
  9. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000Abstract Full text (link to original source) Full text (in our servers)
  10. Hirose M, Hara Y, Hosokawa T, Tanaka Y. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesth Analg. 1996Abstract
  11. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993Abstract Full text (link to original source) Full text (in our servers)
  12. Brooks PM, Needs CJ. Antirheumatic drugs in pregnancy and lactation. Baillieres Clin Rheumatol. 1990Abstract
  13. Goldsmith DP. Neonatal rheumatic disorders. View of the pediatrician. Rheum Dis Clin North Am. 1989Abstract
  14. Needs CJ, Brooks PM. Antirheumatic medication during lactation. Br J Rheumatol. 1985Abstract
  15. Sioufi A, Stierlin H, Schweizer A et al. Recent findings concerning clinically relevant pharmacokinetics of diclofenac sodium. Kass E. Voltaren new findings. Bern: Hans Huber Publishers, 1982:19-30. 1982