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Medications and Mothers’ Milk Safety Information

To be safe, speak with health-care professionals before taking any medication (prescription or non-prescription, natural or herbal, or drug). Every mother is unique and they should look for help from someone knowledgeable about her particular case as needed.

The following are not meant to substitute for specific advice from a healthcare provider, are general guidelines only.

Breastfeeding Friendly Birth Control: Hormonal methods of birth control are best put off until the milk supply is well-established, generally considered 6 weeks after delivery. Some birth control pills, the “patches”, and the “ring” all contain estrogen, therefore are best avoided if there is another choice that will work for the mother.  A special progestin-only “mini” pill does not affect the milk production.  If a combination (estrogen-containing) pill must be used, the “low-dose” combination would be preferred.  No study has shown that exposure to female hormones (estrogen) via mother’s milk is harmful to male infants.

Antibiotics:  Fortunately, antibiotics do not usually cross into the milk in high levels.  The most common complaints are some diarrhea and colic in the baby.  There may also be thrush (fungal infection in the mouth and throat) caused by the overgrowth of Candida yeast.  If there is any bloody diarrhea, the baby’s healthcare provider must be notified!

Penicillins and Cephalosporins:  This group of antibiotics produces less than 0.1% in the breast milk.  It is well tolerated, with only a skin rash sometimes seen in the infant.  As with adults, an allergic reaction is possible, but rare. Diarrhea is also rare.

Erythromycin:  Studies have shown that only a very small amount of this drug enters the milk.  Azithromycin is a “close cousin” to this group.  No side effects have been noted in the infant.

Sulfonamides:  Sulfonamides are generally considered a safe group for older babies.  However, use of these drugs is discouraged during the last trimester (three months) of pregnancy and during the first month of the infant’s life.  They have been shown to increase risk of jaundice in the infant (See BABY PROBLEMS LINK).  It may be better to use a different antibiotic if possible, especially in a baby less than a month old.

Fluoroquinolone:  These antibiotics (Ciprofloxacin, Ofloxacin, and Norfloxacin) are usually used for urinary tract infections.  This group should be avoided and if necessary used with some caution.  They have been shown to cause diarrhea and colitis in the infant.  If this family of drug must be used, Norfloxacin is the drug of choice.

Flagyl:  Depending on the reason for treatment, this drug can be give in just one dose one time, or  two to three times a day for a longer period.  If it is given for only one dose, the mother is encouraged to pump and discard the milk for a 12-hour period.  There is still controversy whether a mother should continue to breast feed if taking this drug for up to 10 days.  Many times, a safer drug can be substituted.  If the mother is being treated for a vaginal infection, a vaginal gel may be used rather than the pills. Then almost no medication is absorbed and this is preferred to taking the pills when breastfeeding.

Aminoglycosides (including Gentamycin):  These drugs are usually only given in the hospital by I.V.  They are so poorly absorbed by the gut that they pose no problems to the breastfeeding infant.

Pain Medications: Mothers who need pain relief need to treat their pain appropriately, so that they will be comfortable and relaxed. Pain and tension can interfere with breastfeeding also, for example, in the new mother recovering from a cesarean delivery.

Opiates:  Opiates are used for severe pain.  They include morphine, Demerol, and fentanyl.  Morphine levels are low in the breastmilk, and pose a low risk for the infant.  Demerol has a longer half-life and has caused significant sedation in the infant.  It should not be used during delivery or postpartum in breastfeeding women.  Fentanyl levels are low in the breastmilk and it has a short half-life.  It poses little risk. Vicodin has been used a lot in breastfeeding mothers and has shown no problems in the infant.  Again, the mother may want to breastfeed away from the peak time of the drug in their system to be sure. Codeine should be avoided if another drug will do, as some mothers have a genetic weakness in the metabolism of this drug. This allows excessive levels to build up, possibly causing over-sedation in the baby, which can interfere with breathing.

Nonsteroidal analgesics:  This includes Naproxen, Ibuprofen – usually used for less severe pain. .  These medications are probably safe because transfer into the milk is low.  Ibuprofen is the best of this group because it can be safely used in infants and the amount in the milk is extremely low.

Acetaminophen (Paracetamol):  This medication is safe to use in low to moderate doses.  This medication enters the milk poorly.  However, long-term high doses should be avoided.

Aspirin:  Levels of aspirin in breastmilk are low.  However, there may be a connection with aspirin and Reyes syndrome.  There is a possibility that an infant that breastfeeds and has a virus could contract this syndrome.  It may be safer to use one of the other medications while breastfeeding.

Anti-convulsants:  In general, anti-convulsants are safe to use for a breastfeeding mom.  They do enter the milk to some degree, and may be measurable in the infant.  The baby’s blood can be taken to measure the amount of medication in the infant’s system.  The mom also should watch for excessive sleepiness or weakness and “droopiness” in the infant.  If there is a concern about the baby, the pediatrician needs to be called immediately.

Cold remedies:  Not a lot is known about the amount of these medications in the milk.  It would be best not to use the medication while breastfeeding if possible due to the effect on milk supply.  Medicated nasal sprays are probably safe because of the low levels in the blood, but are usually not recommended, as they are not very effective and can cause worsening of the congestion after 2-3 days of use.

High Blood Pressure Medication:  Some of these drugs can pass through the breast milk in doses high enough to affect the infant.  Medications in the beta-blocker family, such as Propranolol could slow breathing and cause low blood sugar in the infant.  The ACE inhibitor family should be used very carefully.  Nifedipine, in the “calcium channel blocker” family, is probably the preferred medication.  If sedation, slow heart rate, or low blood pressure is noticed in the infant, the drug needs to be changed, or breastfeeding should be stopped. The prescribing provider and the baby’s provider may need to work together to help choose the safest medication.

Dental Medications:  Most medications used by the dentist are fairly safe.  The only one that should not be used is Meperidine. Local anesthetics (such as Lidocaine or Xylocaine) have minimal levels in the breastmilk.  To be safe, the mom could pump and dump for up to 6 hours after getting the medication.  More than likely, most of the medication would be out of her system by the next feeding.

Vaccines:  Most vaccines are safe to use.  All killed vaccines are safe for the breastfeeding mom.  The only live virus that is questionable is the oral polio vaccine.  This is not because it will harm the infant during breastfeeding, but because it may decrease the infant’s antibodies with later exposure.

Drugs of Abuse:  All brain-altering drugs should be avoided by breastfeeding mothers.  They readily enter the breastmilk and will affect the infant.  Cocaine, pot, and PCP will enter the infants system and can cause positive urine tests for up to a full month.  Cocaine in particular is highly dangerous and should never be used when breastfeeding. Anything that the mother smokes will be inhaled by the infant and have direct effects on the infant.

Antidepressants:  All antidepressants are secreted into the breastmilk to some degree.  This has been an area of a lot of research lately.  The tricyclic antidepressants (TCAs) do not seem to have any long term effects in breastfeeding infants, however, these are not always safe and effective for the mother.  SSRI antidepressants such as Fluoxetine, Sertraline, and Fluoxetine have fewer side effects in the adult, and can be used with caution in the breastfeeding mom.  Fluoxetine is usually not preferred. It has shown side effects in the baby like colic and nervousness, or the opposite- extreme sedation.  Studies have shown that Sertraline has little or no absorption in the breastmilk and cannot be found in the infant’s blood.  Paroxetine has also been shown to have extremely low levels in the breast milk. Citalopram and Escitalopram, being newer, have less data that can be used to make a good recommendation.  In general, short acting formulas of antidepressants are preferred over the once a day, long acting forms, so that the nursing can be done around the dosing as described above. This strategy will minimize the baby’s exposure to the medicine. Herbal products should be used with extreme caution because no studies have been done and there is no information on their safety with breastfeeding.

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