Medicine. Most medications are safe for you to take while breastfeeding. Your baby receives very little of the medication in your milk, and very few meds will affect your milk supply. Tylenol and ibuprofen are fine to take for pain relief and fever, for example. For allergies and colds, most antihistamines are okay, but some decongestants can decrease your milk supply. There’s usually no need to pump and dump when taking medication, but check with your pharmacist or healthcare provider about the safety of any medication while breastfeeding.
IN THIS ARTICLE
- Medications that are safe to take while breastfeeding
- Medicines that may not be safe when breastfeeding
- Medicines that are unsafe when breastfeeding
- Do I need to pump and dump while I’m taking medicine?
Most medications are safe to take when breastfeeding. Very little of the Tylenol you take for your headache will get to your baby, for example, and it won’t affect your milk supply.
There are exceptions, though, so if you need an over-the-counter medication you’re not sure about, work with your healthcare provider or pharmacist to make sure it’s safe. If you need prescription medication, make sure your provider knows that you’re breastfeeding.
The amount of medication that gets into breast milk and how it affects a baby depends on things like the type of medicine, the dosage, how it’s taken, and your baby’s age. Babies who were born preterm or who are younger than 1 month old may have more medication enter their bloodstream because their systems are immature. Medications exit their systems more slowly, too.
Here are some tips for taking medications while breastfeeding:
- Take the lowest dose of an over-the-counter medication possible. (If taking prescription medication, follow your physician’s dosage exactly.) This will result in your baby receiving a lower dose, too, if it appears in your breast milk.
- Avoid long-acting medications, which may remain in your body and breast milk longer.
- Monitor your baby for side effects. Most medications won’t affect your baby, but some might.
- Pay attention to your baby’s weight gain. Some medications can lower milk production, which may lead to poor weight gain for your baby.
- Read the package label for information about the safety of taking any medication while breastfeeding. If you have any questions, talk with your physician or pharmacist.
Medications that are safe to take while breastfeeding
Here are some common medicines that are safe to take while breastfeeding. In standard doses, none of these should affect your milk supply or appear in large enough quantities in your breast milk to have negative consequences for your baby.
Acetaminophen (Tylenol)
Tylenol is considered a good choice for pain relief and fever reduction when you’re breastfeeding. The amount that winds up in your milk is much less than the dosage usually given to infants.
Ibuprofen (Advil, Motrin, Nuprin)
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It’s used to treat aches and pain, inflammation, and fever. Very low levels are found in breast milk, and the safe doses of ibuprofen for infants are much higher than the amounts found in breast milk.
Allergy medicines
“Nondrowsy” antihistamines, nasal sprays, and eye drops can be used during breastfeeding, but avoid oral products containing decongestants such as pseudoephedrine, because they can decrease your milk supply.
Loratidine (Claritin, Alavert), desloratadine (Clarinex), cetirizine (Zyrtec) and fexofenadine (Allegra) are “nondrowsy” antihistamines that are considered safe for breastfeeding moms and their babies. They’re less likely than “first-generation” (earlier) antihistamines to cause sleepiness in your baby (and you).
There’s some concern that first-generation antihistamines, such as diphenhydramine (Benadryl) may reduce the amount of breast milk, though this hasn’t been conclusively proven. It may be more likely when the antihistamine is used along with a decongestant like pseudoephedrine or phenylephrine. First-generation antihistamines are considered safe for breastfeeding, though, when used occasionally.
Nasal sprays such as fluticasone (Nasalide) and oxtnetazoline (Afrin nasal spray) can be used for allergy relief because little is absorbed into your blood or milk.
Cold medicines
Some cold meds are okay to take while breastfeeding. But they contain a combination of ingredients, so you’ll want to read the labels (and check with your pharmacist or healthcare provider) to make sure individual ingredients are okay for breastfeeding moms.
The ingredients in cold medicines are similar to those in allergy meds, including antihistamines and decongestants (see above). Avoid oral decongestants such as pseudoephedrine and phenylephrine, which can decrease milk supply. A nasal spray such as oxymetazoline (Afrin nasal spray) is a safer decongestant option.
Cold medicines also sometimes contain expectorants and cough suppressants, including:
Dextromethorphan (Robitussin), which helps suppress coughs. Dextromethorphan appears in very low levels (if at all) in breast milk and isn’t known to affect a nursing baby.
Guaifenesin (Robitussin, Mucinex) is an expectorant that helps loosen respiratory secretions. It’s considered safe while nursing.
If you have trouble finding a cold medicine with breastfeeding-safe ingredients, you may be better off taking individual ingredients to address specific problems, as needed. For example, you may use a nasal spray for congestion and acetaminophen or ibuprofen for headache relief. And if you’re struggling with stuffiness or coughing, you can also take Robitussin, which contains the cough suppressant dextromethorphan and the expectorant guaifenesin.
Be sure to read label ingredients to make sure you’re not doubling up on anything when you take individual medications.
Antidepressants
Sertraline (Zoloft) and paroxetine (Paxil) are SSRI antidepressants that are recommended during breastfeeding. Only very low levels appear in breast milk, and no serious side effects have been reported in breastfed infants. Mothers taking SSRIs during and after pregnancy sometimes have more difficulty breastfeeding, though researchers don’t know if it’s because of the medication or the illness.
Nortriptyline (Pamelor) is a tricyclic (cyclic) antidepressant and is considered a preferred antidepressant while breastfeeding. Low levels of the drug are found in breast milk. No immediate or long-term effects have been found in the nursing baby, though studies are limited.
Trazodone (Oleptro, Desyrel) is used to help with depression and sleep. Limited reports find that levels in breast milk are low and that it’s safe while breastfeeding, especially for babies older than 2 months or when doses of 100 mg or less are used at bedtime.
Imipramine (Tofranil) and Amitriptyline (Elavil) are tricyclic antidepressants that are found in low levels in breast milk. While sedation has been reported occasionally, no other immediate effects have been found in breastfeeding babies, and research has found no effects on growth and development.
Anxiety medications
Lorazepam (Ativan) is a benzodiazepine that has a short half-life (it doesn’t stay in the system for long) and is safely used in infants. It appears in low levels in breast milk.
Oxazepam (Serax) appears in low levels in breast milk and also remains in the body a short time compared to other benzodiazepines. It’s used safely in infants.
Antibiotics and antifungals
Antibiotics can sometimes cause a disruption of the normal bacteria in a baby’s intestinal tract. Watch for symptoms of diarrhea and yeast infection (diaper rash, thrush).
Ciprofloxacin (Cipro) is used for bacterial infections. It belongs to a group of antibiotics called fluoroquinolones. A breastfeeding baby would get only a small amount in breast milk, lower than the dose they would receive directly for treatment.
Penicillins, such as penicillin V, dicloxacillin, and amoxicillin, are used to treat bacterial infections and are considered safe while breastfeeding.
Cephalosporins (Keflx, Ceclor, Ceftin, Omnicef, Suprax) are antibiotics similar to penicillins and are acceptable during breastfeeding.
Fluconazole (Diflucan), which is used to treat fungal and yeast infections, hasn’t been shown to have an adverse effect on infants.
Erythromycin (E-Mycin, Erythrocin) is used for skin and respiratory infections and is considered safe while breastfeeding. Low levels are found in breast milk, and it’s sometimes given directly to infants.
Vancomycin (Vancocin) is an antibiotic that’s considered safe while breastfeeding. Low levels are found in breast milk, and it’s not well absorbed orally.
Tetracyclines are safe for short-term use when nursing. Tetracycline sometimes causes the staining of teeth when taken by children, so there’s some concern that the medication could cause staining of a breastfeeding infant’s teeth (when they come in later). But the amounts of tetracycline in breast milk are low, the calcium in breast milk inhibits its absorption, and tooth staining has never been reported with breastfeeding. To be safe, don’t use tetracycline for a prolonged period or repeatedly when breastfeeding. Doxycycline is the preferred tetracycline during breastfeeding because it’s unlikely to cause tooth staining.
Antacids
Calcium carbonate (Tums) is used as an antacid for heartburn, indigestion, and upset stomach. Taking calcium carbonate in recommended doses isn’t likely to be harmful to a breastfeeding baby.
Magnesium and aluminum hydroxide combinations (Maalox, Mylanta) are common antacids. They’re not well absorbed, so they won’t get into your milk.
The acid-reducing medications omeprazole (Prilosec) and pantoprazole (Protonix) have been studied in nursing mothers and are given directly to infants. They’re considered acceptable for breastfeeding moms.
Histamine 2 blockers (H2 blockers) reduce the amount of acid produced by the stomach. Famotidine (Pepcid) is the preferred H2 blocker. The amounts of famotidine found in milk are lower than with similar drugs such as cimetidine (Tagamet).
Corticosteroids (cortisone, hydrocortisone, prednisone)
Corticosteroids are used to treat joint inflammation, inflammatory bowel disease, asthma, allergies, and other conditions. They may be taken by mouth, inhaler or nasal spray, eyedrops, topically, or injection. The amount found in breast milk is very low, and no negative effects have been reported in babies. Corticosteroids are considered safe during breastfeeding.
Asthma medicine
Inhalers used for asthmas, such as bronchodilators (albuterol) and corticosteroids (fluticasone), are safe during breastfeeding because only small amounts are absorbed.
Constipation medicine
Medicines for constipation, such as Metamucil and Colace, are considered safe because they don’t appear in breast milk. Some herbal laxatives, such as cascara, can be absorbed and cause diarrhea in the baby, so it’s better to avoid them.
Medicines that may not be safe when breastfeeding
The following drugs should be used with caution – because they may affect your milk supply or your baby. Before taking these medications, be sure to tell your healthcare provider or a pharmacist that you’re breastfeeding. If you’re nursing a newborn or premature infant, you may want to ask your provider if there are alternatives.
- Naproxen (Aleve, Anaprox, Napralen, Naprosyn) is a NSAID used to treat pain and fever. Small amounts of naproxen appear in breast milk, but the drug lasts longer in your body and your baby’s than other SNAIDs. It may be best to choose another NSAID, such as ibuprofen, especially while breastfeeding a newborn or preterm infant.
- Pseudoephedrine (Sudafed, Aleve-D, Allegra-D, Claritin-D, Mucinex-D, Zytec-D) is a decongestant. It’s not unsafe for your baby. (Less than 1 percent of pseudoephedrine ends up in breast milk.) But it may reduce breast milk production, so you may want to avoid it.
- Some medicines for high blood pressure and abnormal heart rhythms, such as acebutolol (Sectral), atenolol (Tenormin), nadolol (Corgard) chlorthalidone, and clonidine (Catapres)
- Antihistamine/decongestant combinations, such as Contac and Dimetapp. These may reduce your milk supply.
- Fluoxetine (Prozac, Sarafem) produces an amount of the drug in breast milk that’s higher than with other SSRIs. It may cause fussiness, colic, and drowsiness in breastfeeding babies, though no long-term developmental effects have been found.
- Long-acting benzodiazepines used to treat anxiety disorders and for sleep, such as Librium, Valium, and Dalmane.
- Phenylephrine (Sudafed PE), a decongestant. Though we don’t have information about its safety while breastfeeding, animal studies show it may reduce breast milk supply.
- Diphenhydramine (Benadryl), chlorpheniramine (Chlor-Triaminic, Chlor-Trimeton, Chlor-Tabs), and hydroxyzine (Vistaril) are older first-generation antihistamines that are more likely to cause drowsiness or irritability in you and your baby. An occasional dose isn’t likely to be harmful.
- Some antibiotics: Clindamycin (Cleocin) is an antibiotic used to treat abdominal and vaginal infections. Oral clindamycin may cause problems such as diarrhea, thrush, diaper rash, or colitis in a breastfed baby. Use on the skin away from the breast won’t affect the infant. Metronidazole (Flagyl), an antibiotic used to treat some intestinal and genital infections, may cause diarrhea and fungal infections in a breastfeeding infant. Nitrofurantoin (Macrobid, Macrodantin), used to treat urinary tract infections, is safe to take if your baby is at least 1 month old.
- Opioid (narcotic) pain relievers can cause drowsiness and reduced breathing (apnea) in infants, especially in the first 4 to 6 weeks of life. Use the least amount possible of these drugs after your milk comes in. Try to use safer drugs like acetaminophen or ibuprofen instead.
Medicines that are unsafe when breastfeeding
These drugs aren’t safe for breastfeeding moms to take. Ask your healthcare provider if there’s a safer alternative for you. If you must take a certain medication, you may not be able to breastfeed, or you may have to stop temporarily.
- Chloramphenicol, an antibiotic used for serious bacterial infection
- Doxepin, a tricyclic antidepressant
- Ergots, used for migraines
- Most cancer medications (antineoplastic agents)
- Iodine products, such as Betadine used for douching and potassium iodide, an expectorant.
- Radioactive iodine-131, used to diagnose and treat hyperthyroidism.
- Metamizole (dipyrone), a pain reliever and anti-inflammatory. This medication is banned in the U.S. but is available in Mexico (dipirona or metamizole in Spanish).
- High doses of aspirin (to treat arthritis, for example). Aspirin appears in small quantities in breast milk, but it might increase the risk of Reye’s syndrome and may cause bleeding problems in infants. There are times when the benefits of taking aspirin outweigh the risks, and your doctor can help you evaluate which amounts are safe for you and your baby, if necessary.
- Gold salts (Myochrysine), for arthritis
- Amiodarone (Cordarone), used to treat heart problems
Do I need to pump and dump while I’m taking medicine?
“Pump and dump” means using a breast pump to empty your breasts and then dumping out the milk you collect. Doing this when you can’t give your milk to your baby enables you to keep up your milk supply and eventually start nursing again.
Pumping and dumping is rarely needed. If your provider advises you to stop breastfeeding while taking medicine, ask if there’s an alternative medicine that’s safe for your baby.
In some cases, it might be possible to take your medication immediately after nursing, wait a while, then nurse your baby again just before it’s time to take your next dose. Ask your provider if this approach is safe for your baby.
If you know in advance that you’ll have to pump and dump, consider pumping and freezing your milk ahead of time, so you’ll have enough stockpiled before you start taking your medication.
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