Analgesia: Pregnancy, breastfeeding, paediatric

Analgesia

Dose (adult)	Paediatric	Route	Pregnancy	Breastfeeding
Ibuprofen
200-400mg 4-8H	5-10mg/kg 4-8H (for age specific dose, refer to BNF for Children)	Oral	·                     C/ D (≥30 weeks gestation) ·                     Not recommended unless potential benefits outweigh possible hazards.b	·  Contraindicated (Canadian prescribing information). ·  Based on limited data, excreted into breast milk, providing a relative infant dose of 0.06 to 0.6% of the weight adjusted maternal dose. ·  Adverse events have not been reported in nursing infants. ·  Not recommended unless expected benefits  outweigh potential risk.b
Diclofenac Sodium
75-150 mg/day in 2-3 divided doses. Maintenance: 75 mg/daily (or 100mg/daily)b in over 2-3 divided doses. Max duration: 2 days.	Child 2–18 years:  0.3–1 mg/kg Once or twice daily for max. 2 days (max. 150 mg daily)	IM	·                     C/ D (≥30 weeks gestation) ·                     Should not be usedb	·  Low concentrations can be found in breast milk. Contraindicated in Canadian labelling. ·  Not recommended. Following oral doses of 50mg administered every 8 hours, the active substance, diclofenac passes into breast milk.b
Depending on the size of painful site, apply 2-4gm TDS-QIDb	Adolescent ≥16 years: Refer to adult dosing.	Gel	·                     B (topical gel 3%) / C (topical gel 1%) ·                     Since no experience has been acquired, it is not recommended.b	·  It is not known if it is excreted in breast milk.
50mg 8-12H4	Child 6 months–18 years 0.3–1 mg/kg  (max.50 mg) 3 times daily3 0.5-1mg/kg 8-12H4	Oral	·                     C/ D (≥30 weeks gestation) ·                     During late pregnancy should be avoidedb	·  Low concentrations can be found in breast milk. ·  Contraindicated in Canadian labelling. ·  Not recommendedb
Mefenamic Acid
500mg 8H4	Child 12–18 years 500 mg 3 times daily3 10mg/kg 8H4	Oral	·                     C	·  Trace amounts may be present in breast milk. ·  Contraindicated in Canadian labelling.
·                     Aspirin
300-600mg 4-6H4 300-900mg 4-8H, up to maximum of 12 tablets  daily (per24 hours)b	10-15mg/kg 4-6H4	Oral	·                     Cross placenta & enter fetal circulation. Adverse effects reported in fetus and mother. In general, low doses during pregnancy have not been shown to cause fetal harm, but discontinuing therapy prior to delivery is recommended. ·                     Don’t take during last 3 months of pregnancy unless ordered by doctor.b	·  Low amounts can be found in breast milk. Peak levels in breast milk are reported (9 hours after a dose). ·  Occasional doses of aspirin compatible with breast-feeding, but avoid long-term therapy & consider monitoring infant for adverse effects (WHO, 2002). ·  Other sources suggest avoid due to theoretical risk of Reye’s syndrome (Bar-Oz,2003; Spigset,2000). ·  Pass into breast milk. Not been reported to cause problems in nursing babies, possible that problems may occur if large amounts are taken regularly, as for arthritis.b

^bManufacturer’s recommendation

*for other indication please refer to other guideline

**Because of the known effects of NSAIDs on the foetal cardiovascular system (closure of ductus arteriosus), use during late pregnancy should be avoided.

References

1. http://www.mims.com/malaysia

2.https://www.drugs.com/

3. BNF for Children 2014–2015

4. Drug Doses, Frank Shann, 16^th Edition 2014

5. Lexicomp