Medicine and Breastfeeding: What’s Safe and What to Avoid

Breastfeeding is an excellent way to enhance your child’s development. Typically, breast milk delivers all of the necessary nutrients in the perfect ratios for the nourishment of a growing baby. Additionally, breast milk helps build the immune system and protect your child from sickness, reduce the incidence and development of allergies, and even protect against infections, diabetes, and cancer.

Furthermore, breast milk is easily digested, allowing nutrition without the interference of indigestion, constipation, and diarrhea and it also promotes weight regulation as the baby grows (breastfed children tend to maintain healthier weights as they age).

Breastfed children are widely regarded for being markedly healthier than their formula-fed counterparts, as formula-fed infants have higher rates of gastrointestinal upset, ear infections, and allergies. Formula-fed infants are at as much as 100% higher risk than that of babies who are breastfed for at least their first six months of life.

Breastfeeding is not always a feasible option, especially when the mother has a low breast milk supply due to (but not limited to): insufficient glandular tissue, Polycystic Ovarian Syndrome (PCOS), previous mastectomy or breast reduction, hypothyroidism, or radiation used to treat breast cancer before conception. Other factors that may prevent a mother from breastfeeding include addiction to illegal substances, a medication that is contraindicated during pregnancy, infectious diseases (such as HIV, HTLV, TB, and Herpes lesions on the breasts).

In cases when breastfeeding is an option, however, a mother should be well educated on what is within the realms of safety, including being aware that anything that a breastfeeding mother eats or drinks can pass through to the infant through her breast milk. When you consider this, it is critically important to monitor what you consume because it can pass to the baby. Most medications, while they do pass into breast milk, do so at low levels that are unlikely to pose any risk to the infants. However, some drugs are the exception as they can build up and become quite concentrated within breast milk, posing a risk to the infant.

As a general rule, babies six months or older are at a much lower risk for adverse reactions to medications whereas newborns, babies born prematurely, and medically unstable infants are at higher risk for adverse reactions upon exposure to certain medicines.

Always consult your doctor before continuing, discontinuing, or altering the dosage of any medicine, medication, or prescription drugs. Always consult with your doctor about potential risks to your infant and contraindications while pregnant or breastfeeding.

So, is it safe to take over-the-counter medicine while breastfeeding?

The short answer is: typically, yes.

Like stated before, only trace amounts of medicine taken by the mother pass into her breast milk, and as a result, there are only a few that arguably shouldn’t be taken by a mother who is breastfeeding.

When in doubt, a couple of rules of thumb are effective for determining whether or not it is safe to take a medication while breastfeeding, such as:

Is the drug regularly prescribed for infants? If it is regularly prescribed, it’s most likely not contraindicated, and it is safe for mothers to take while breastfeeding. This is an easy conclusion, especially when given that the amount that would be ingested by the infant would be far less than if the infant had been administered a dose. Additionally, if it is safe at an administered dose, a trace amount is unlikely to pose a risk. Of course, consult your physician to discuss contraindications specific to you and your baby.

Is the drug safe to take during pregnancy? If the drug is deemed safe during pregnancy, it is probably safe to take while breastfeeding, though some exceptions do apply. As always, consult your physician.

The Center for Disease Control (CDC) offers numerous resources for referencing general information regarding the safety of medicine while breastfeeding, such as LactMed, a Toxnet Database – which is an online database for drugs and lactation. It is hosted by the U.S. National Library of Medicine and offers a search engine for breastfeeding mothers to find extensive information about drug safety and contraindications pertaining to breastfeeding. On the front page under the subject, “What is LactMed?” the website states,

“The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency.”[ref. 3]

Additionally, the database is updated on a monthly basis, making it a substantially reliable source for breastfeeding mothers.

The Basics: What Medications are Safe to Take While Breastfeeding?

While it is always important to consult with your primary physician before taking any medications (breastfeeding or not), below is a basic (and by no means exhaustive) list of medications that are generally safe to take while breastfeeding. If you are considering a medication that is not on this list, we recommend that you reference LactMed’s database for a quick check before consulting your physician for confirmation.

Pain Relievers/Fever Reducers:

  • Ibuprofen
    • Brands included: Advil, Motrin, IBU
  • Acetaminophen
    • Brands included: Tylenol, Paracetamol, Panadol, Mapap, etc.

Allergy Relief/Antihistamines:

  • Loratadine
    • Brands included: Claritin, Alavert, etc.
  • Fexofenadine
    • Brands included: Allegra Allergy, Allegra, Allegra Hives, Aller-Ease, etc.

Antimicrobial/Antifungal medications:

  • Fluconazole
    • Brands included: Diflucan
  • Miconazole
    • Brands included: Oravig, Monistat, Micatin, Vusian, Rash Relief Antifungal (use all sparingly)
  • Clotrimazole
    • Brands included: Mycelex, Lotrimin, Lotrisone, etc. (use sparingly)
  • Penicillins
    • Such as amoxicillin and ampicillin
  • Cephalosporins, such as Cephalexin
    • Brands included: Keflex, Zartan, Daxbia, Keftab

Decongestants:

  • Pseudoephedrine
    • Brands included: Sudafed, SudoGest, Entex, Zyrtec D, Nexafed, etc.

Use with caution. Pseudoephedrine has been associated with decreased milk supply, so consider natural alternatives when possible, especially while breastfeeding.

Selective Serotonin Reuptake Inhibitors (SSRS, Antidepressants):

  • Paroxetine
    • Brands included: Paxil, Brisdelle, Pexeva
  • Sertraline
    • Brands included: Zoloft
  • Fluvoxamine
    • Brands included: Luvox, Luvox CR

Gastrointestinal Relief:

  • Famotine
    • Brands included: Pepcid, Pepcid AC, Heartburn Relief, Fluxid
  • Climetidine
    • Brands included: Tagamet HB, Tagamet, Leader Heartburn Relief, Equaline Acid Reducer

What about Nyquil and Gravol?

Both Nyquil and Gravol, while not dangerous, may contain ingredients that can be unsafe for the infant if you are breastfeeding (for example, Nyquil often contains a significant amount of alcohol).

Generally, cold medicine (acetaminophen, ibuprofen), allergy medicine, and cough medicine are safe to take while breastfeeding.

Additionally, it is recommended for breastfeeding mothers to use Menthol products (such as cough drops) with caution, as some women report decreased milk supply when using menthol products though there have not been any studies to confirm this. There is published literature regarding Peppermint and its use during lactation, though there is no mention regarding Peppermint’s potential effects on milk supply.

Natural Alternatives to Medications

While breastfeeding, many mothers may prefer to avoid medicine and pharmaceutical medications altogether (when possible) by utilizing natural alternatives.

Unfortunately, regulatory standards for dietary supplements, including (but not limited to) herbs, botanicals, vitamins, minerals, and enzymes should always be purchased from a reputable source. A registered dietitian, nutritionist or physician should direct the dose to ensure that the supplements used are potent, high quality, and at an optimal and safe dose.

Some safe and good natural remedies include honey (a natural analgesic, or a component used for sore throat), garlic (high in quercetin, a flavonoid antioxidant known for its ability to reduce histamines), and herbs, such as elderberry and echinacea, to improve immune health.

Takeaway:

Most medications are safe in moderation, though it is always a must to consult with a primary physician or naturopath. Ibuprofen and Acetaminophen tend to be safer options than Nyquil or Gravol. Natural alternatives are available but should be used with direction from a Naturopath, Registered Dietician, or Nutritionist.

Additional Notes:

Caffeine and alcohol should be monitored while pregnant and breastfeeding. While breastfeeding, an occasional glass of wine is not harmful (though it is recommended to dilute with fruit juice or water) and drinking up to 10-ounces of coffee per day is generally regarded as safe.

If you have taken any medications and notice your child is exhibiting signs of a reaction, such as altered sleeping patterns, changes in hunger, fussiness, rash, or any other concerning symptoms, consult your baby’s primary physician immediately.

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