Analgesics are one of the most prescribed drugs during the postpartum period to prevent and treat pain and inflammatory disease. The focus on analgesics during breastfeeding has increased because of lack of information and fatal codeine intoxication in a breastfed neonate. Ibuprofen has an advantageous benefit–risk ratio profile compared with codeine. There is a lack of information on drug transfer into human milk, thus ibuprofen intake during breastfeeding may be debated. Consequently, there is a dilemma whether to terminate breastfeeding or drug therapy. The objective of this study was to determine the relative infant dose of ibuprofen.
The first week after the delivery, each woman received ibuprofen to treat pain or inflammatory disorders (mean dose, 1012 ± 96 mg/d). Just after the third dose of ibuprofen, 1 milk sample and 2 blood samples were obtained after 1 week of breastfeeding. Ibuprofen concentrations in breast milk and blood were measured by using high-performance liquid chromatography.
Twenty women were included after written informed consent, and 13 gave their breast milk and blood samples. The mean ibuprofen milk concentration was 360 ± 160 mcg/L. The mean fat milk concentration was 3.23 ± 1.15 g per 100 mL, and the mean milk protein concentration 0.87 ± 0.27 g per 100 mL. The ibuprofen transfer infant dose (theoretical infant dose) was 68 mcg·kg−1·d−1 (8–262 mcg·kg−1·d−1), and the relative infant dose was <0.38% (0.04%–1.53%) of the weight-adjusted maternal daily dose, which equals 0.2% of the infant dose.
The results confirm that the transfer of ibuprofen into breast milk decreases with the protein concentration and the duration of lactation. These results suggest that the use of ibuprofen is compatible with prolonged breastfeeding after the early postpartum stage.
*Human Milk Bank Ile de France, Paris;
†Medic-Al Network, Necker Hospital, AP-HP, Paris;
‡Pharmacokinetic and Clinical Toxicology Purpan Hospital, Toulouse; and
§Cochin Necker Hospital Clinical Research Unit, AP-HP, Paris, France.
Correspondence: Raphael Serreau, MD, PhD, Medic-Al Network, Lactarium, Necker Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP) Ministry of Health, 149 rue de Sèvres 75015 Paris, France (e-mail: firstname.lastname@example.org).
The authors declare no conflict of interest.
Received November 16, 2012
Accepted January 28, 2014