Which drug can be safely used in lactating mothers?
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Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. Few medications are contraindicated while breastfeeding. Show
Note to Breastfeeding Mothers Tell your health care provider and your baby’s provider about any medications or supplements you are taking, including vitamins, herbs, and over-the-counter products. Is it safe for mothers to use prescription medications while breastfeeding?Usually. A 2013 clinical report by the American Academy of Pediatrics (AAP), “The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics,external icon” indicates that most medications and immunizations are safe to use during lactation. According to the AAP, health care providers should weigh the risks and benefits when prescribing medications to breastfeeding mothers by considering the following:
Review LactMed®external icon for the most up-to-date information available on medications and lactation when advising breastfeeding mothers on medication safety. Note to Breastfeeding Mothers Tell your health care provider and your baby’s provider about any medications or supplements you are taking, including vitamins, herbs, and over-the-counter products. Where can I search for specific medications and their safety in mothers while breastfeeding?The US National Library of Medicine (NLM) at the National Institutes of Health (NIH) maintains LactMed®external icon, a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed. LactMed®external icon includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data come from scientific literature and are fully referenced. A peer review panel reviews the data for scientific validity and currency. The Organization of Teratology Information Specialists (OTIS) provides information, in English and Spanish, for women and health care providers on the risks and safety of taking medication during pregnancy and breastfeeding. This group maintains a website called Mother to Babyexternal icon. The InfantRisk Centerexternal icon provides up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding. The InfantRisk Center also provides resources such as a free call center, MommyMeds mobile app for consumers, and InfantRisk mobile app for health care professionals. Connect with Nutrition, Physical Activity, and Obesity Page last reviewed: November 30, 2020 To receive email updates about this topic, enter your email address. 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 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. 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. Some drugs require a doctor’s supervision during their use. Taking them safely while breastfeeding may require the following:
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.
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. CLICK HERE FOR THE PROFESSIONAL VERSION Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Which of these medications should not be used by breastfeeding mothers?Pain pills and fever reducers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Medications for acid reflux and heartburn like antacids (Maalox, Mylanta, Tums) and histamine H2 blockers or proton-pump inhibitors (Pepcid AC, Zantac, Prilosec) Laxatives (Metamucil, Colace). Most antibiotics.
Is diclofenac safe in lactation?You can take diclofenac while breastfeeding. Only very small amounts get into breast milk which are unlikely to cause side effects in your baby. Many breastfeeding mothers have used it without any problems.
Is morphine safe for lactating mothers?Morphine, codeine, hydrocodone, fentanyl, and hydromorphone have been determined, by several studies, to be moderately safe for breastfeeding women. However, morphine is the preferred opiate to use by a breastfeeding mother due to its poor oral bioavailability.
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