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Medication and breastfeeding
Breastfeeding offers a range of health benefits for a mother and her newborn baby. Breastmilk offers the baby protection against infection and studies have indicated that breastfed children are less likely to develop skin allergies, asthma, diabetes and bowel disease later in life and have improved cognitive development.  Breastfeeding also helps bonding between a mother and her baby.
Although it is always advisable for nursing mothers to tell their doctor or pharmacist that they are breastfeeding, nursing mothers do not necessarily need to avoid taking all types of medication. Most medication is considered safe for breastfeeding mothers. However, exposure to medication in breastmilk poses a significant risk to babies.
While many medications can potentially harm a developing fetus during pregnancy, most medications do not pass through to the breastmilk in sufficient quantities to harm the health of the newborn baby. Natural barriers are contained in the cells that produce breastmilk that make it difficult for most medication to be passed into the milk. Any medication that does transfer through to the breastmilk only does so in small amounts, well below the therapeutic dose for an infant.
Taking medication while breastfeeding involves striking a balance between protecting a nursing mother from the potential harm of not treating her underlying condition, and protecting her baby from exposure to the medication. Avoiding medication altogether may actually cause harm to the mother and her baby if a medical condition goes untreated.
There are some established ways to minimise the transfer of medications to the nursing baby, including:
- Where possible, using an alternative route of administration. For instance, consider a nasal spray instead of tablet form;
- Using the lowest recommended therapeutic dose;
- Taking the medications immediately after a feed to minimise the amount of drug in the next feed, and;
- Where possible, using an alternate drug therapy.
If a medication is prescribed that may be harmful to the baby, you will need to stop breastfeeding at least temporarily, and use a breast pump to maintain your milk supply until you can resume breastfeeding. Your doctor can advise you on when and how long to cease breastfeeding for.
While taking medications, monitor the newborn for any unusual signs or symptoms, such as a rash, sleeping changes or change in their mood.
Commonly-used medications considered safe for nursing mothers.
Allergies and hay fever
The non-sedating antihistamines loratadine and fexofenadine are considered safe. However, some older antihistamines may cause irritability or sleepiness in the newborn baby. Such preparations include promethazine and pheniramine.
Nasal sprays with beclomethasone, fluticasone or budesonide are considered safe, as are eye drops containing antazoline and naphazoline.
Since the evidence is still unclear on the safety of anaesthetic agents with breastfeeding, is it usually advised to stop breastfeeding for 24 hours, and to dispose of breastmilk during this time ('pump and dump'). Usually, breastfeeding can resume thereafter. However, it is best to discuss your breastfeeding plan with your anaesthetist before your procedure.
Penicillins, cephalosporins and macrolides are considered safe antibiotics to take while breasfeeding. Quinolones have not been well studied and are not recommended.
Warfarin does not appear to pass into breastmilk and is considered safe.
Cabamazepine, ethosuximide, magnesium sulphate and phenytoin are considered safe; however, there may be some risks associated with the use of valproic acid.
Loperamide is considered safe.
Fluconazole, miconazole and ketoconazole are considered safe.
Beta-blockers and diuretics that are commonly used as antihypertensives are generally considered safe at standard doses. The beta-blockers propranolol, metoprolol and labetalol are considered safe; however, atenolol, nadolol and sotalol may not be recommended.
Antipsychotics, anti-anxiety medicines and antidepressants
The evidence is still unclear about the safety of long-term use of these drugs in nursing mothers. They may alter the function of the nervous system.
Acyclovir and valacyclovir are considered safe.
Inhaled asthma medication is considered safe for breastfeeding mothers. Oral steroids such as prednisone or prednisolone only pass minimally into the breastmilk and are considered safe. For daily dosages over 20mg, prednisolone may be preferred over prednisone.
Cold and flu
Nasal spray decongestants and saline nasal drops are considered safe, but oral preparations that contain pseudoephedrine may reduce milk production and cause irritability in the baby.
Most cough medicines are safe, but preparations containing pseudoephedrine and phenylephrine may cause irritability in the baby and reduce milk production.
Most lozenges for sore throats are also safe to use, but those containing povidone-iodine are not recommended.
The safest laxatives are those using fibre-based products. Taking large doses of preparations containing senna may cause diarrhoea in the baby.
The progesterone-only pill is considered the best option for contraception during breastfeeding, as it has only minimal transfer to the breastmilk and does not affect milk production, whereas the combined oestrogen-progesterone pill may decrease the quantity and alter the composition of the milk.
Injectable contraceptives are only excreted into the breastmilk at very low amounts and are considered safe to use. The morning-after pill is considered safe for emergency contraception.
Dietary supplements and herbal preparations
B-group vitamins are considered safe. However, herbal preparations may contain chemical substances that could be harmful to the baby and are not recommended.
Using higher than the standard dose of any dietary supplement is not recommended.
Famotidine, omeprazole and cimetidine are considered safe.
In general, it is considered safe for a nursing mother to receive most vaccinations.
Because insulin is not excreted into breastmilk, it is considered safe.
Pain can be treated during lactation with a range of medication. Poorly-managed pain can potentially lead to depression and anxiety.
Paracetamol is considered safe, as the baby only receives around 6% of the maternal dose. Ibuprofen, diclofenac, indomethacin and naproxen are also considered safe, as the baby only receives around 1% of the maternal dose.
Aspirin is not considered safe as it may be associated with adverse effects; the infant dose is around 10% of the maternal dose. There is also a potential link with Reye's syndrome.
Short-term use of opioids is not likely to be a risk to the infant, but longer-term or chronic use may be potentially dangerous. If longer-term pain relief is required during breastfeeding, other options may be considered.
Medication considered unsuitable for nursing mothers
Medications that are not considered safe for your baby while you are breastfeeding include: