Introduction

A breastfeeding mother may encounter certain health problems for which she may be prescribed medications. In such situations, she may wonder if breastfeeding should be continued or stopped temporarily until the drug therapy is over. While most pharmaceutical drugs are safe, there are certain types that may cause side-effects in the baby or interfere with breast milk production.

Therefore, it is best to seek the advice of a medical doctor before deciding to take any medicine, be it prescription, non-prescription, natural or herbal. Mothers should be informed that a drug which is safe to take during pregnancy may not necessarily be safe for a nursing baby.

Some points to ponder before taking medication during breastfeeding:

1. Is the medication necessary?
2. Will the medication affect your baby?
3. Will the medication affect your ability to produce breast milk?
4. What other alternative treatment options are available?

Answering these questions will help you weigh the risks against the benefits of taking a particular medication. You may also want to consider whether timing the dosage can minimize your baby’s exposure to the medication. If it is absolutely necessary to avoid breastfeeding while taking a medication, consider temporarily stopping breastfeeding but maintaining milk production by expressing and discarding the breast milk.

Most Medications Are Safe

In most cases, prescription and over-the-counter medications are safe while breastfeeding. In general, medications that are applied to the skin, eyes or nose or inhaled such as drugs for asthma as well as those that are commonly prescribed to infants are safe. The infant’s drug exposure depends on its concentration in breast milk and the amount of milk consumed. Only a licensed medical professional can prescribe or recommend a drug to a breastfeeding mother or evaluate the safety of a drug for an individual mother and baby.

Usually, the drug’s compatibility with breastfeeding is evaluated based on the baby’s age, medical history, the mother’s health, and other possible alternatives. Always monitor your baby for any signs of adverse reaction to the drug while continuing to breastfeed.

Everyone reacts differently to a medication. Individual circumstances, such as diet or other medications you are taking, can affect how you react to a particular drug. Your doctor will take these factors into consideration when prescribing a medication. Weaning is seldom necessary when a breastfeeding mother needs to take medication.

Discussing With Your Doctor

Because every situation is unique, it is important to gather information about a medication and discuss closely with your doctor, particularly if there is any uncertainty about a medication’s suitability for you or your breastfed baby. It is always important to tell your doctor that you are breastfeeding, whether your child is a newborn, a six-month-old baby, or a nursing toddler. Many doctors may assume that an older baby has been weaned.

If your doctor has given the go-ahead for you to take medication while breastfeeding, try not to worry about it anymore. If you are still concerned, find out the reasons why it is considered compatible with breastfeeding so you can feel more confident in the recommendation.

If your doctor recommends a drug that is incompatible with breastfeeding, explain to him or her that breastfeeding is important to you and that you prefer not to stop. Ask if there are alternative medications, or non-drug treatments available as alternatives. There is certainly a world of difference between treating a minor ailment and a life-threatening condition, therefore you may want to ask the doctor to find more information on the medication. Further investigation may reassure your doctor that a medication is indeed safe for breastfeeding mothers to use.

Information on Specific Drugs

Medications are typically divided into three categories:

1. Common medications that are safe to use in usual dosage while breastfeeding;
2. Medications that can be taken while breastfeeding but require careful monitoring by a doctor;
3. Medications that should not be used while breastfeeding.

(Adapted from “Breastfeeding counselling: A training course”, WHO/CDR/93.3-6).

1. Common medications that are safe to use in usual dosage while breastfeeding:

• Analgesics and antipyretics: short courses of paracetamol, acetylsalicylic acid, ibuprofen; occasional doses of morphine and pethidine.

• Antibiotics: ampicillin, amoxicillin, cloxacillin and other penicillins, erythromycin.

• Antituberculosis drugs, anti-leprosy drugs (see dapsone above).

• Antimalarials (except mefloquine, fansidar), anthelminthics, antifungals.

• Bronchodilators (e.g. salbutamol), corticosteroids, antihistamines.

• Antacids, drugs for diabetes, most antihypertensives, digoxin.

• Nutritional supplements of iodine, iron, and vitamins.

2. Drugs that can be taken while breastfeeding but require careful monitoring by a doctor:

• Side-effects possible; monitor baby for drowsiness:
  • Selected psychiatric drugs and anticonvulsants (see individual drug).
• Use alternative drug if possible:
  • Chloramphenicol, tetracyclines, metronidazole, quinolone antibiotics (e.g. ciprofloxacin).
• Monitor baby for jaundice:
  • Sulfonamides, dapsone, sulfamethoxazole+trimethoprim (cotrimoxazole), Sulfadoxine and pyrimethamine (fansidar).
• Use alternative drug (may decrease milk supply):
  • Estrogens, including estrogen-containing contraceptives, thiazide diuretics, ergometrine.

3. Drugs that should not be used while breastfeeding:

• Sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations may cause side effects such as drowsiness and respiratory depression and are better avoided if a safer alternative is available;

• Radioactive iodine-131 is better avoided given that safer alternatives are available – a mother can resume breastfeeding about two months after receiving this substance;

• Excessive use of topical iodine or iodophors (e.g., povidone-iodine), especially on open wounds or mucous membranes, can result in thyroid suppression or electrolyte abnormalities in the breastfed infant and should be avoided;

• Cytotoxic chemotherapy requires that a mother stops breastfeeding during therapy.

Tips to Reduce Your Baby’s Exposure to Medicine

The amount of medication to which an infant is exposed depends on several factors, such as the dosage of medication, when and how often it is taken, and how quickly the mother metabolizes the medication. The safety of certain medications also depends on the age of the infant. Nearly all reported adverse effects in nursing infants have occurred in infants less than six months old. Newborns and premature infants are most at risk.

If you are concerned about the effect your medication may have on your baby, even if you have been told by your doctor that it is safe to breastfeed, there are a number of things you can do to minimiseexposure. For example, it is often best to take the drug right after breastfeeding, so it has time to be voided from your system before you nurse again. However, different medications are absorbed and eliminated at different rates.

Taking medication before your baby’s longest sleep period may also be a good idea. However, this approach may not be practical for newborns, who typically feed every two to three hours, or with drugs that take a long time to be metabolised. It is important that breastfeeding mothers consider the schedule of administration when making a decision about taking a medication.

It is best to avoid taking over the counter products, including natural and herbal remedies while breastfeeding, unless cleared by your doctor. Always consult your doctor before changing your medication and make sure to review the risks and benefits before making any decisions.

Take the medication as directed so that you can be a happy, healthy mother to your baby.

References

1. “Breastfeeding counselling: A training course”, WHO/CDR/93.3-6
2. Breastfeeding and maternal medication: recommendations for drugs in the Eleventh WHO Model List of Essential Drugs. Geneva, World Health Organization, 2003.
3. The Breastfeeding Answer Book Pocket Guide, by Nancy Mohrbacher (LLLI 2005).