Whether you get migraines or just brutal headaches, chances are you have a bottle of Excedrin (acetaminophen, aspirin, and caffeine) in your medicine cabinet. But if you’re nursing, experts recommend you steer clear of this medication. “I don’t recommend Excedrin while a mom is breastfeeding,” says Maureen Mills, RN, IBCLC, a lactation consultant at Potomac Pediatrics in Rockville, MD. Learn why you should avoid Excedrin while breastfeeding and what you can choose instead.
What Is Excedrin?
The three ingredients in Excedrin work together to help alleviate head pain. “Excedrin is an over-the-counter (OTC) medication that is a combination of acetaminophen, aspirin, and caffeine,” explains pharmacotherapy specialist Aaron Emmel, PharmD, MHA, BCPS, director of educational programs at PharmacyTechScholar.com. “It is most commonly used for the treatment of migraine headache attacks, but it is sometimes used for other headaches or minor aches and pains.” Dr. Emmel explains that while the mechanisms for all of them aren’t completely understood, acetaminophen and aspirin are both analgesics, meaning they are meant to relieve pain. They do this by blocking a pathway in the brain (called the cyclooxygenase pathway) that may cause pain and, in the case of acetaminophen, stimulating a pathway (the serotonergic pathway) that reduces pain. Caffeine works a little differently. “Unlike the other two ingredients, caffeine appears to inhibit receptors that are activated by adenosine, a substance that may play a more specific role in migraine headaches," says Dr. Emmel. Altogether, the three ingredients make Excedrin the top migraine relief medication in a recent survey of pharmacists conducted by Pharmacy Times and U.S. News and World Report.
Is It Safe to Take Excedrin While Breastfeeding?
It is best to avoid taking Excedrin while breastfeeding. While lactating and nursing won’t impact Excedrin’s ability to potentially get rid of your migraine, the issue lies with aspirin, which you don’t want getting into your breastmilk and into your baby’s system. “Although only small amounts will secrete into the breastmilk, [aspirin] can have the potential to cause bleeding problems in the infant and an increased risk for Reye’s Syndrome, which causes liver damage," says Mills. Reye’s Syndrome is a rare but serious childhood condition that causes swelling in the liver and brain. A study published in The BMJ found a strong link in children between being given aspirin after the appearance of symptoms and the full-blown development of the disease. “The recommended dose of two Excedrin tablets for a migraine headache provides 500mg of aspirin, which is more than double the low dose that some experts think is safe to use while breastfeeding,” adds Dr. Emmel. While Reye’s Syndrome is rare and the evidence against aspirin is not conclusive, experts agree that taking it while breastfeeding isn’t worth the risk.
Risks of Excedrin While Breastfeeding
Taking Excedrin comes with some potential side effects for the nursing parent as well. “Many people assume that OTC medications are very safe, but there are significant concerns with each of the ingredients for some people,” Dr. Emmel says. In addition to small amounts of aspirin getting to your baby through your breastmilk, it can also cause gastrointestinal ulcers and bleeding. “Acetaminophen can cause liver toxicity, even in doses within the recommended daily limit,” Dr. Emmel adds. “Those with a history of liver problems, use of other liver-toxic medications, or alcohol use may be at highest risk.” While the amounts of acetaminophen (250mg), aspirin (250mg), and caffeine (65mg) in one dose of Excedrin are small enough that negative side effects and dangers are unlikely, the greater risk comes from accidentally combining the drug with other sources of the ingredients. “Acetaminophen and aspirin are commonly included in other OTC products,” says Dr. Emmel. “The amount of caffeine present in one tablet is similar to an average cup of coffee. Patients should be careful not to exceed a healthy daily limit of caffeine.” While caffeine is generally safe to consume in moderation while breastfeeding, drinking a cup or two of coffee and then popping a pill that also contains caffeine can take you past the healthy limit for you and your baby.
When Can I Resume Using Excedrin?
To prevent any aspirin from getting into your breastmilk and into your baby’s system, you should wait to resume using Excedrin until after you are no longer breastfeeding.
Breastfeeding Safe Alternatives
Excedrin is not the best choice for fighting migraines and headaches if you are breastfeeding. Instead, there are other medications and strategies you can use to combat head pain during this period.
Advil or Motrin
In a study published in the American Journal of Obstetrics and Gynecology, no measurable amount of ibuprofen was found in the breastmilk of women who took 400mg every six hours. And according to the American Migraine Foundation, drugs like Advil and Motrin are as effective as prescription medications for pain relief. “Ibuprofen is the preferred analgesic that I recommend while moms are breastfeeding,” says Mills.
Tylenol
While taking the three ingredients found in Excedrin together is not recommended, Tylenol (acetaminophen) may be helpful for fighting headaches on its own during this period. “Since the amount of medication secreted in the breastmilk is minimal, Tylenol is my second choice for breastfeeding moms,” Mills says. According to the NIH’s Drugs and Lactation Database, no acetaminophen was detected in the urine of breastfed infants after their mothers took 650mg of acetaminophen.
Botox
In a study published in the journal Headache, Botox (onabotulinumtoxin A) treatment was found to reduce the number of headache days in migraine patients by 50%. And a 2017 study in the International Journal of Women’s Dermatology found that the use of Botox injections during breastfeeding was unlikely to cause any harm to the baby. So if you are struggling with migraines 15 or more days a month and the OTC solutions just don’t cut it, Botox may be a smart solution—plus, since it’s an FDA-approved treatment, most health insurance plans will cover it.
A Word From Verywell
While Excedrin is an effective OTC treatment for migraines and other headaches for most people, you should avoid taking it while breastfeeding. The aspirin in the drug has been linked to an increased risk for Reye’s Syndrome, a rare but serious childhood condition that affects the liver and brain. What’s more, because it contains a significant dose of caffeine (the same as one cup of coffee), taking Excedrin during a headache episode may inadvertently send you over the recommended daily intake for caffeine while breastfeeding. Fortunately, there are other effective ways to fight headaches and migraines during this period. To find the one that’s best for you, talk to your OBGYN, neurologist, or other healthcare provider.
