Most common COVID-19 symptoms can be safely treated while breastfeeding. Acetaminophen and ibuprofen are both considered first-line options for fever and body aches, and the main antiviral treatment, Paxlovid, is not recommended to be withheld from lactating women. The key is knowing which specific medications are safe, which ones can quietly reduce your milk supply, and which one you should avoid entirely.
Fever and Body Aches
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the go-to choices for fever, headaches, and the general achiness that comes with COVID. The American College of Obstetricians and Gynecologists lists both as first-line pain relievers for breastfeeding women. Drug safety during lactation is measured by something called the relative infant dose, which is the percentage of a mother’s dose that reaches the baby through milk. Anything under 10% is generally considered acceptable, and both acetaminophen and ibuprofen fall well within that threshold.
You can take either one at standard over-the-counter doses. Some people alternate between the two for better fever control, which is also fine while nursing.
Paxlovid and Antiviral Treatment
If you’re at higher risk for severe COVID (due to asthma, obesity, diabetes, or other conditions), antiviral treatment is worth discussing with your provider. The CDC’s current guidance states that COVID-19 treatment should not be withheld from lactating women because of theoretical safety concerns. Paxlovid (nirmatrelvir/ritonavir) is the most commonly prescribed oral antiviral, and it’s typically started within five days of symptom onset for the best effect.
One antiviral you should be aware of is molnupiravir. Breastfeeding is not recommended during treatment with molnupiravir and for four days after the last dose. If this is the only option available to you, you would need to pump and discard your milk during that window to maintain supply, then resume nursing afterward.
Cough and Sore Throat Relief
For a nagging cough, guaifenesin (Mucinex) is considered unlikely to harm a nursing infant at usual doses, especially in babies over two months old. Its transfer into breast milk hasn’t been formally studied, but the expected exposure is very low. If you’re using a liquid formulation, check the label and avoid products with a high alcohol content.
Dextromethorphan, the cough suppressant found in many “DM” products, is also generally considered compatible with breastfeeding at standard doses.
For sore throat, honey in warm tea is a simple option that works surprisingly well as a cough suppressant and throat soother. Cleveland Clinic specifically recommends it as an alternative when breastfeeding mothers want to limit medication use. Throat lozenges and warm saltwater gargles are other low-risk options.
Congestion: What to Use and What to Skip
This is where breastfeeding mothers need to be most careful. Pseudoephedrine (Sudafed) is an effective decongestant, but a study of eight women found that a single 60 mg dose reduced milk supply by 24% over 24 hours. That’s a significant drop, and repeated doses could compound the problem. If you’re working to maintain or build your supply, pseudoephedrine is best avoided.
Saline nasal sprays and rinses (like a neti pot) are completely safe and can provide real relief from congestion without any medication reaching your milk. Steam inhalation, a hot shower, or a humidifier in your room are other supply-friendly options. Nasal strips can also help you breathe more comfortably at night.
Antihistamines and Runny Nose
If COVID gives you a runny nose or persistent sneezing, second-generation antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) are the preferred choices for breastfeeding women. They transfer into breast milk at low levels and are far less likely to cause side effects in your baby.
First-generation antihistamines like diphenhydramine (Benadryl) are a second-line option. They’re known to cause drowsiness and irritability in infants exposed at therapeutic doses, and some older antihistamines can also reduce milk supply. If you need an antihistamine, stick with loratadine or cetirizine.
Corticosteroids for Severe Cases
Dexamethasone is sometimes used for more severe COVID-19 cases that involve low oxygen levels. If you’re sick enough to need it, the priority is treating your illness. However, medium to large doses of corticosteroids, including dexamethasone, have been reported to temporarily reduce milk production. In one documented case, a breastfeeding mother’s milk supply stopped completely during a course of intravenous dexamethasone but returned within 36 hours of discontinuing the drug and reached normal levels after about eight days. If you end up needing corticosteroids, your supply will likely recover once the course is finished.
What to Watch for in Your Baby
Even with medications considered safe, it’s worth keeping an eye on your baby for any changes while you’re being treated. Signs to watch for include unusual sleepiness or difficulty waking, changes in feeding patterns (nursing less or refusing the breast), unexpected fussiness, rash, or appearing unusually limp or floppy. Breathing difficulties are the most urgent concern. These reactions are uncommon with the medications listed above at standard doses, but noticing them early matters.
Quick Reference: Safe vs. Caution vs. Avoid
- Safe at standard doses: acetaminophen, ibuprofen, guaifenesin, dextromethorphan, loratadine, cetirizine, saline nasal spray, honey
- Use with caution: diphenhydramine (may cause infant drowsiness), dexamethasone (may reduce milk supply temporarily)
- Avoid: pseudoephedrine (significant milk supply reduction), molnupiravir (breastfeeding not recommended during treatment and for 4 days after the last dose)
Staying hydrated, resting as much as possible, and continuing to nurse or pump regularly will help both your recovery and your milk supply. COVID-19 itself does not pass to babies through breast milk, and your milk provides antibodies that may help protect your infant.