What Medications Are Safe While Breastfeeding?

The American Academy of Pediatrics recommends newborns be exclusively breastfed for the first 6 months of life. Additionally, they recommend breastmilk be supplemented with complementary foods until the child is 1 year old, but can be continued until the child reaches 2 years and beyond. Therefore, it is essential to understand what medications are safe to take while breastfeeding.

Key takeaways:
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    Breastfeeding provides numerous health benefits to the mother and the developing baby.
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    Use resources such as the National Library of Medicine’s drug database to determine if a medication is safe to take while breastfeeding.
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    Acetaminophen and Ibuprofen are safe pain relievers to use while breastfeeding.
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    Antihistamines and pseudoephedrine can significantly reduce milk production and thus should be used with caution in women having difficulty producing enough milk.
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    Before taking any new medication, discuss its safety during breastfeeding with your doctor or pharmacist.

Breastfeeding

Breastfeeding has numerous benefits for your child and is recommended for all children up to 1 year of age and beyond. Breastfed babies have been shown to have a lower risk of obesity, asthma, type 1 diabetes, and sudden infant death syndrome (SIDS). In addition, breastmilk contains antibodies that can help boost the newborn’s immune system and make them less susceptible to illnesses during early life.

However, health benefits are not only seen in the child but also in the mother. Breastfeeding can help reduce the risk of breast cancer and ovarian cancer in mothers. Additionally, it can help mothers lose the additional weight gained during pregnancy, reduce postpartum bleeding, and cause the uterus to contract and return to its original size.

The act of breastfeeding helps to improve the physical and emotional bonding between the infant and the mother. This can help to reduce the risk of maternal postpartum depression, increase positive feelings, and reduce stress through the release of the maternal hormones, oxytocin, and prolactin.

Not only does it provide emotional benefits for the mother but breastfed babies have been shown to cry less overall. However, many mothers are concerned about taking medications while breastfeeding and the harm they can cause the developing newborn.

Medications and breastfeeding

The safety of medication during breastfeeding is related to many different factors. Healthcare providers must consider the mechanism of action of the medication, as well as whether the medication can enter into breast milk and to what degree. There are no clinical studies to assess the risk of a medication for the developing newborn.

Pharmacists and doctors must evaluate drugs from a scientific approach to determine if the medication is safe to use during pregnancy. They will often determine the estimated relative infant dose (RID) which provides an estimate of the amount of drug the infant receives during breastfeeding.

Therefore, it is especially important to discuss with your doctor and/or pharmacist about taking medication while breastfeeding. They can help you determine if there is a significant risk to your child and whether that medication can be stopped while breastfeeding. It is important to have this discussion to maximize the overall benefits for yourself and your child.

Prescription medications

Unfortunately, it is impossible to discuss every medication and its safety during breastfeeding in a single article. However, the National Library of Medicine has developed a database that allows you to find information about breastfeeding and any medication. Mothers are encouraged to use this database to better understand the risk of certain medications on their child.

Having this information and discussing it with your physician or pharmacist will help you make the decision about what is right for you!

Over-the-counter (OTC) medications

Even though OTC medications are available without a prescription they still require caution when used while breastfeeding. Here are a few recommendations for the most common groups of OTC meds.

Pain relief options:

  • Acetaminophen and ibuprofen are safe to use while breastfeeding.
  • Naproxen should be avoided as it can cause bleeding, anemia, and low platelet counts in newborns.
  • Aspirin should be avoided, however, a low dose daily aspirin is ok if needed for heart protection.

Cold and flu options:

  • Antihistamines can decrease milk production and cause drowsiness in newborns, however, non-sedating (loratadine and fexofenadine) can be used on a short-term basis.
  • Pseudoephedrine can be used if a decongestant is needed but it can decrease milk production. Oxymetazoline nasal sprays (Afrin) are safe to use but should not be used for more than 3 consecutive days.
  • Dextromethorphan is safe to use if a cough suppressant is needed.
  • Phenylephrine and guaifenesin have limited information regarding their use in breastfeeding and thus should be avoided.

Gastrointestinal (GI) options:

  • Loperamide (Imodium) can be safely used in breastfeeding mothers when needed for diarrhea.
  • Bismuth subsalicylate (Pepto-Bismal) should be avoided.
  • Laxatives such as psyllium, MiraLAX, bisacodyl, senna, and docusate are all safe to use while breastfeeding.
  • H2-blockers such as famotidine are considered to be safe options for the treatment of heartburn.
  • Antacids such as calcium carbonate (Tums) are safe to use while breastfeeding.
  • Omeprazole is a proton pump inhibitor used for heartburn that is considered safe to use, however, limited data exist on its use in mothers breastfeeding.

Breast milk provides numerous benefits to the developing newborn and is recommended as the exclusive food source during the first 6 months of life. Additionally, breastfeeding provides the mother with many mental and physical health benefits. However, many medications can have adverse effects on the baby and care must be used when deciding whether a medication should be taken or not.