Can I take NyQuil while breastfeeding?

What is in NyQuil?

NyQuil comes in many versions, and they do not all contain the same drugs. These are the active ingredients from 2 common versions' own Drug Facts labels on DailyMed. Check your exact box, because the ingredients change from one version to the next.

• NyQuil Cold & Flu liquid (per 30 mL): acetaminophen 650 mg (the drug in Tylenol), dextromethorphan 30 mg (cough suppressant), and doxylamine 12.5 mg (a drowsy antihistamine). Adults take 30 mL every 6 hours, no more than 4 doses in 24 hours. The label lists alcohol as an inactive ingredient, and the bottle front says Alcohol 10%.
• NyQuil Severe Cold & Flu liquid (per 30 mL): acetaminophen 650 mg, dextromethorphan 20 mg, doxylamine 12.5 mg, and phenylephrine 10 mg (a decongestant). Adults take 30 mL every 4 hours, no more than 4 doses in 24 hours. This label does not list alcohol.
• What both labels say about breastfeeding: if you are pregnant or breastfeeding, ask a health professional before use.

Can doxylamine make my baby sleepy?

It can, and it is the main reason to be careful. LactMed says small, occasional doses of doxylamine would not be expected to cause problems in breastfed babies. It also says larger doses or longer use may cause drowsiness and other effects in the baby, or decrease your milk supply. That risk is higher when doxylamine is combined with a decongestant such as pseudoephedrine, or when your milk supply is not yet well established.

There is not much data. LactMed found no studies measuring doxylamine in breast milk or in babies' blood. In 1 follow-up study of mothers taking various antihistamines, mothers reported irritability or colic-like symptoms in 10% of babies and drowsiness in 1.6%. None of these needed medical care. LactMed also describes a single report of a partly breastfed toddler who became sleepy while the mother took doxylamine with another medicine.

Doxylamine affects you too. The NyQuil label warns that marked drowsiness may occur. If you will be caring for your baby alone overnight or feeding in bed, think about whether a sedating medicine is a good fit for that night.

What about the alcohol, acetaminophen and dextromethorphan?

These 3 are less of a worry than the antihistamine, but each has a note.

• Alcohol: the standard NyQuil Cold & Flu liquid lists alcohol as an ingredient, and its bottle label says Alcohol 10%. LactMed's dextromethorphan entry says it is best to avoid products with a high alcohol content while nursing. LactMed does not say what counts as high, so if you want to avoid alcohol, NyQuil Severe Cold & Flu liquid does not list it. Do not drink alcohol while taking NyQuil: the label says to avoid alcoholic drinks.
• Acetaminophen (Tylenol): LactMed calls it a good choice for pain and fever in nursing mothers. Amounts in milk are much less than the doses usually given to babies, and side effects in breastfed babies appear to be rare. Do not take Tylenol or any other acetaminophen product on top of NyQuil: the label says not to use it with any other drug containing acetaminophen.
• Dextromethorphan: LactMed says that when it is used as a cough syrup, the amounts in breast milk are very low and are not expected to affect the baby. In 1 study of 20 mothers who took a single 30 mg dose, the baby's estimated dose was well under 1% of the mother's, adjusted for weight. Do not take NyQuil if you take a prescription MAOI (a type of antidepressant) or stopped one in the last 2 weeks: the label says so.

Is NyQuil Severe or a decongestant version worse while breastfeeding?

It may be, because of your milk supply. NyQuil Severe adds phenylephrine. LactMed says very little oral phenylephrine reaches the baby, but taking it by mouth might decrease milk production, so another drug may be preferred, especially with a newborn or premature baby. LactMed adds that phenylephrine nasal spray is less likely to lower supply.

Some cold medicines use pseudoephedrine instead. LactMed's doxylamine entry warns that doxylamine combined with pseudoephedrine may cause drowsiness in the baby or lower milk supply. If you are struggling with supply, or your baby is a newborn, skip decongestant versions unless your doctor says otherwise.

The NyQuil Severe label also says to ask a doctor before use if you have heart disease, high blood pressure, thyroid disease or diabetes, and not to use it with an MAOI or within 2 weeks of stopping one.

What can I take instead of NyQuil while breastfeeding?

Treat only the symptoms you have, with single-ingredient medicines. Ask a pharmacist to check your choice and tell them you are breastfeeding and how old your baby is.

• Fever, sore throat, aches: plain acetaminophen (Tylenol), which LactMed calls a good choice for nursing mothers. Or plain ibuprofen (Advil, Motrin), which LactMed calls a preferred choice because levels in milk are extremely low. Pick the 1 that fits your symptoms, follow its label, and ask a pharmacist if you take other medicines or have health conditions.
• Cough: a single-ingredient dextromethorphan product. LactMed says amounts in milk are very low. Choose one without a high alcohol content, and do not take it along with NyQuil, since NyQuil already contains dextromethorphan.
• Stuffy nose: LactMed says phenylephrine nasal spray is less likely to lower milk supply than decongestant pills. Ask a pharmacist how many days you can use a spray.
• If you do take NyQuil: stick to 1 product, take the label dose for the shortest time you need it, pick a version without a decongestant if you can, and never add a second product with acetaminophen, dextromethorphan, a decongestant or an antihistamine.

Does my baby's age matter?

Yes. LactMed's cautions single out newborns, premature babies, and mothers whose milk supply is not yet well established. For doxylamine, the warning about drowsiness and lower supply is stronger before lactation is established. For phenylephrine, LactMed says another drug may be preferred while nursing a newborn or premature baby.

If your baby is a newborn or premature, has a health condition, or takes medicines, ask your baby's doctor or a pharmacist before taking NyQuil. LactMed does not give an age cutoff, so treat this as a reason to ask, not a fixed rule.