Introduction

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. [1]  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.

Most medications do not pass through to the breastmilk in sufficient quantities to harm the health of the newborn baby.Most medications do not pass through to the breastmilk in sufficient quantities to harm the health of a newborn baby. 

Allergies

A harmful, hypersensitive immune reaction to usually innocuous environmental substances.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

Fetus

An unborn human, from the ninth week of pregnancy until birth.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Cognitive

Relating to cognition, which are the mental processes and abilities associated with acts of judgement, reasoning and understanding.

Bowel disease

Chronic diseases that affect the digestive system, such as ulcerative colitis and Crohn's disease.

1. Breastfeeding support and promotion. The Royal Children’s Hospital Melbourne. Accessed 19 November 19 2014, from

External link

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.

Anaesthetic agents

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.

Antibiotics

Penicillins, cephalosporins and macrolides are considered safe antibiotics to take while breasfeeding. Quinolones have not been well studied and are not recommended.

Anticoagulants

Warfarin does not appear to pass into breastmilk and is considered safe.

Anticonvulsants

Cabamazepine, ethosuximide, magnesium sulphate and phenytoin are considered safe; however, there may be some risks associated with the use of valproic acid.

Antidiarrhoetics

Loperamide is considered safe.

Antifungals

Fluconazole, miconazole and ketoconazole are considered safe.

Antihypertensives

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.

For treatment of depression, evidence indicates that selective serotonin reuptake inhibitors (SSRIs) may be a better choice, although this may require ongoing monitoring of the breastmilk and baby.

Antiviral

Acyclovir and valacyclovir are considered safe.

Asthma

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.

Constipation

The safest laxatives are those using fibre-based products. Taking large doses of preparations containing senna may cause diarrhoea in the baby.

Contraception

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.

Heartburn

Famotidine, omeprazole and cimetidine are considered safe.

Immunisation

In general, it is considered safe for a nursing mother to receive most vaccinations.

Insulin

Because insulin is not excreted into breastmilk, it is considered safe.

Pain relief

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. 

Anaesthetic

A medication or other substance that causes a temporary loss of sensations, including pain.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Antihistamines

A substance that counters the physiological effects of histamine, a type of compound released by the tissues as an inflammatory response to an allergic reaction.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Beta-blockers

Substances that hinder the activity of hormones such as adrenaline by blocking the beta receptors, found in many organs but particuarly the heart and blood vessels. These are used to treat a range of conditions including high blood pressure and migraines.

Decongestants

A substance that reduces congestion or swelling in the body, particularly in the nasal cavity.

Depression

A mental health disorder that results in physical and psychological symptoms such as low mood, a feeling of hopelessness, poor concentration and motivation, disruptive sleep patterns and appetite changes. To be diagnosed with depression, these symptoms must be present most days for at least two weeks.

Diuretics

A substance that promotes the production and excretion of urine.

Insulin

A hormone secreted by the pancreas in order to regulate glucose levels in the body's cells, which is used for energy.

Iodine

A chemical element important for hormone development that is found in foods including dairy products, seafood, eggs, bread and some vegetables. It is often used in medicine as a dye.

Laxatives

Any substance that causes or encourages bowel movements.

Nervous system

The extensive network of cells and structures that is responsible for activating and coordinating the body's functions, sensory input and cognition.

Oestrogen

One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.

Opioids

A class of drugs that contain opium, derivatives of opium, or have similar effects to opium. They are powerful painkillers that act on the central nervous system and cause drowsiness and include drugs such as morphine and pethidine.

Progesterone

A female sex hormone produced by the ovaries and the placenta during pregnancy. It also plays an important role in the menstrual cycle.

SSRIs

A type of antidepressant medication.

Steroids

A class of chemical substances that have a certain complex of carbon particles. The body produces several types of steroids naturally and artificially-produced steroids are used as medications.

Vaccinations

The practice of administering a vaccine, a solution containing a microorganism (that causes a specific disease) in a dead or weakened state, or parts of it, for the purpose of inducing immunity in a person to that microorganism.

Reye's syndrome

A life-threatening condition that can occur in young children, characterised by brain inflammation and liver failure. Aspirin is a potential cause, especially when used in young children and teenagers with chickenpox, flu-like symptoms or other viral infections.

1. Breastfeeding support and promotion. The Royal Children’s Hospital Melbourne. Accessed 19 November 19 2014, from

External link

Medication considered unsuitable for nursing mothers

Medications that are not considered safe for your baby while you are breastfeeding include:

Iodine

A chemical element important for hormone development that is found in foods including dairy products, seafood, eggs, bread and some vegetables. It is often used in medicine as a dye.

Lithium

A metal element that is used in medications that treat psychiatric illnesses.

Retinoids

A group of medications that act like vitamin A, a fat-soluble vitamin essential for bone growth, vision and reproduction.

Nuclear medicine

An examination that uses radioactive substances and a scanning device to determine the structure and function of different organs.

1. Breastfeeding support and promotion. The Royal Children’s Hospital Melbourne. Accessed 19 November 19 2014, from

External link