When mothers who are breastfeeding have to take a drug, they wonder whether they should stop breastfeeding. The answer depends on the following:
How much of the drug passes into the milk
Whether the drug is absorbed by the baby
How the drug affects the baby
How much milk the baby consumes, which depends on the baby's age and the amount of other foods and liquids in the baby's diet
Some drugs, such as epinephrine, heparin, and insulin, do not pass into breast milk and are thus safe to take. Most drugs pass into breast milk but usually in tiny amounts. However, even in tiny amounts, some drugs can harm the baby.
Some drugs pass into breast milk, but the baby usually absorbs so little of them that they do not affect the baby. Examples are the antibiotics gentamicin, kanamycin, streptomycin, and tetracycline.
When possible, drugs should be taken immediately after breastfeeding or before the baby's longest period of sleep.
Drugs That Are Relatively Safe During Breastfeeding
Drugs that are considered safe include most nonprescription (over-the-counter) drugs. Exceptions are antihistamines (commonly contained in cough and cold remedies, allergy drugs, motion sickness drugs, and sleep aids) and, if taken in large amounts for a long time, aspirin and other salicylates. Acetaminophen and ibuprofen, taken in usual doses, appear to be safe.
Drugs that are applied to the skin, eyes, or nose or that are inhaled are usually safe.
Most antihypertensive drugs Drug therapy High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more do not cause significant problems in breastfed babies. Women may take beta-blockers during breastfeeding, but the baby should be checked regularly for possible side effects, such as a slow heart rate and low blood pressure.
Caffeine and theophylline do not harm breastfed babies but may make them irritable. The baby's heart and breathing rates may increase.
Even though some drugs are reportedly safe for breastfed babies, women who are breastfeeding should consult a health care practitioner before taking any drug, even an over-the-counter drug, or a medicinal herb. All drug labels should be checked to see whether they contain warnings against use during breastfeeding.
Did You Know...
Drugs That Require a Doctor’s Supervision During Breastfeeding
Some drugs require a doctor’s supervision during their use. Taking them safely while breastfeeding may require the following:
Adjusting the dose
Limiting the length of time the drug is used
Timing when the drug is taken in relation to breastfeeding
Most antianxiety drugs Antianxiety and Sedative Drugs Antianxiety and sedative drugs are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more , antidepressants Drug therapy for depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , and antipsychotic drugs Antipsychotic drugs Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more require a doctor’s supervision, even though they are unlikely to cause significant problems in the baby. However, these drugs stay in the body a long time. During the first few months of life, babies may have difficulty eliminating the drugs, and the drugs may affect the baby’s nervous system. For example, the antianxiety drug diazepam (a benzodiazepine) causes lethargy, drowsiness, and weight loss in breastfed babies. Babies eliminate phenobarbital (an antiseizure drug and a barbiturate) slowly, so this drug may cause excessive drowsiness. Because of these effects, doctors reduce the dose of benzodiazepines and barbiturates as well as monitor their use by women who are breastfeeding.
Warfarin (a drug that prevents blood from clotting) can be taken if the baby is full-term and healthy. Warfarin does not appear to enter breast milk. People who take warfarin, including women who are breastfeeding, need to have blood tests done periodically to determine whether blood is clotting normally. Warfarin can cause a tendency to bruise or bleed.
Drugs That Should Not Be Taken While Breastfeeding
Some drugs should not be taken by mothers who are breastfeeding Breastfeeding Breast milk is the ideal food for newborns. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend exclusive... read more . They include
Chemotherapy drugs Chemotherapy and Other Systemic Cancer Treatments Systemic treatments are those that have effects throughout the body rather than being applied directly to the cancer. Chemotherapy is a form of systemic treatment that uses drugs to kill cancer... read more (such as cyclosporine, doxorubicin, and methotrexate)
Chloramphenicol (an antibiotic)
Ergotamine (used to treat migraine headaches)
Illicit drugs such as cocaine Cocaine Cocaine is an addictive stimulant drug made from leaves of the coca plant. Cocaine is a strong stimulant that increases alertness, causes euphoria, and makes people feel powerful. High doses... read more , heroin Opioids Opioids are a class of drugs derived from the opium poppy (including synthetic variations) that are pain relievers with a high potential for misuse. Opioids are used to relieve pain, but they... read more , and phencyclidine Ketamine and Phencyclidine (PCP) Ketamine and phencyclidine are chemically similar drugs used for anesthesia but are sometimes used recreationally. Ketamine is available in powder and liquid form. The powder can be snorted... read more (PCP)
Drugs that may suppress milk production
Drugs that may suppress milk production include bromocriptine (used to treat Parkinson disease), estrogen Hormone Therapy for Menopause Menopause is the permanent end of menstrual periods and thus of fertility. For up to several years before and just after menopause, estrogen levels fluctuate widely, periods become irregular... read more , oral contraceptives Oral Contraceptives Contraceptive hormones can be Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings) Applied to the skin (patch) Implanted under the skin read more that contain high-dose estrogen and a progestin, trazodone (an antidepressant), and levodopa Levodopa/carbidopa Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more .
If women who are breastfeeding must take a drug that may harm the baby, they must stop breastfeeding. But they can resume breastfeeding after they stop taking the drug. While taking the drug, women can maintain their milk supply by pumping breast milk, which is then discarded.
Women who are breastfeeding should consult their health care practitioner about all the drugs they are taking or about to start.
Women who smoke should not breastfeed within 2 hours of smoking and should never smoke in the presence of their baby whether they are breastfeeding or not. Smoking reduces milk production and interferes with normal weight gain in the baby.
Alcohol consumed in large amounts can make the baby drowsy and cause profuse sweating. The baby's length may not increase normally, and the baby may gain excess weight. Drinking up to 1 standard drink per day does not appear to harm the breastfeeding infant, especially if the woman waits at least 2 hours after a single drink before breastfeeding.