Most commonly-used medications are safe while breastfeeding, especially those that are safe to give directly to the baby.
References
Some good places to look up medications and drugs for breastfeeding mothers
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The InfantRisk Center
Provides up-to-date evidence-based information on medication use in pregnancy and breastfeeding (with a smart phone app)
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Drugs that reduce milk supply in some mothers
- hormonal contraceptives (including progestogen-only)
- antihistamines
- decongestants
- high-dose vitamin B6
- nicotine
- diuretics
- some sedatives
- some weight loss medications
Drug cautions and contraindications during breastfeeding
Use a medication compatible with breastfeeding whenever possible. Even a short interruption in breastfeeding can decrease breastmilk supply and risk lactation failure with the need for relactation.
When prescribing any of the medications listed below, consultation with a pharmacist experienced in lactation or other appropriate expert is recommended.
- Anticonvulsants - in healthy term infants, if benefit is greater than risk, valproate or carbamazepine may be considered. With valproate, watch the baby for rash (especially bruising) and hepatic dysfunction, and with carbamazepine, watch the baby for hepatic dysfunction and poor suckling/sedation.
- Antineoplastics and immune suppressants - even small amounts in breastmilk pose risk. Steroids are okay when topical, inhaled, or given in a dose equivalent to 40 mg prednisone or less.
- Ergots - bromocriptine stops lactation, as do higher-dose / longer-term ergonovine and ergotamine. Infant ergotism is a risk with ergotamine. Short-term low-dose methylergotamine may be considered when monitoring the mother’s milk supply and the baby (for vomiting, weight loss, and weak pulse.)
- Gold - if given during breastfeeding, babies should be closely monitored. Reported milk levels vary widely and aurothiomalite has been measured in both urine and plasma of infants.
- Iodine - Iodine-containing compounds are not recommended during breast-feeding, because iodine passes easily into breastmilk and can cause hypothyroidism in the baby.
- Lithium Carbonate - Breastfed babies of some mothers receive up to 40% of the mothers’ weight-adjusted dose but others get much less. Because breastfeeding can be very beneficial in manic-depression, Motherisk advises that breastfeeding start and continue as long as the baby shows no signs of toxicity (e.g., floppiness, decreased responsiveness, T-wave abnormalities) and the baby’s blood lithium is monitored and stays well below therapeutic levels (i.e., 30-40% of maternal level when the mother’s level is in the therapeutic range.) Consider carbamazine or valproate (see above) as alternatives.
- Radiopharmaceuticals - consult a nuclear medicine physician to select the radionuclide with the shortest excretion time. If possible, mothers should stock breastmilk before receiving a radionuclide, then pump and discard until breastmilk is radiation-free. See LactMed (above) for specific isotopes.
- Alcoholic drinks - alcohol moves freely into and out of breastmilk, rising and falling with the mother’s blood alcohol level. Mothers should breastfeed before drinking alcohol, then delay nursing until 2 hours after 1 standard drink, 4 hours after 2 standard drinks, etc. (Standard drink = 12oz/360cc regular beer, 5oz/150cc wine, .5oz/45cc spirits.)
- Cigarette smoking - nicotine and its metabolites are detectable in milk. Breastfeeding is important for babies of smokers, but smoking while breastfeeding is associated with reduced breastmilk supply and with colic in the baby.
- Street drugs can pass into breastmilk and even tiny amounts can have adverse effects on the baby. Maternal cocaine use has caused infant toxicity. Maternal marijuana use is linked to slower infant motor development at one year of age.
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