Breastfeeding and Medications: A Comprehensive Guide for Moms

Breastfeeding is a natural and healthy way to nourish infants, providing them with essential nutrients and antibodies to help them grow and develop. However, many new moms may have concerns about taking medications while breastfeeding and how it may affect their milk supply and the health of their infants.

This comprehensive guide aims to provide moms with the information they need to make informed decisions about taking medications while breastfeeding. It will cover important topics such as medication safety, how medications can affect breast milk production, and which medications are safe to take while breastfeeding.

Breastfeeding moms can rest assured that most medications are safe to take while breastfeeding. However, it is important to consult with a healthcare provider before taking any medication to ensure that it is safe for both the mother and the infant. This guide will provide moms with the knowledge they need to have open and informed discussions with their healthcare providers about taking medications while breastfeeding.

Understanding Medications and Breastfeeding

Breastfeeding mothers may need to take medications for various reasons, such as treating illnesses, managing chronic conditions, or undergoing medical procedures. However, they may also have concerns about the safety of medications for their infants, as some drugs can pass into breast milk and potentially affect the baby's health and development. Therefore, it is essential for mothers to understand the risks and benefits of medications while breastfeeding and consult with their healthcare providers before taking any drugs.

Several resources are available to help mothers and healthcare providers make informed decisions about medications and breastfeeding. One such resource is the LactMed database, which provides evidence-based information on the safety of prescription and over-the-counter medications, herbal remedies, and dietary supplements during lactation. LactMed is maintained by the National Institutes of Health and reviewed by a peer review panel of experts in lactation and pharmacology.

Another resource is the InfantRisk Center, which offers a call center and a mobile app to provide personalized consultations and information on medications and breastfeeding. The InfantRisk Center is staffed by healthcare professionals, including obstetricians, pediatricians, and pharmacists, who can help mothers and providers evaluate the risks and benefits of medications and suggest therapeutic alternatives if necessary.

Mothers should also communicate with their healthcare providers, including doctors and lactation consultants, about their medications and breastfeeding plans. Healthcare providers can review the package insert of medications, which contains information on the drug's pharmacology, metabolism, and adverse effects, and monitor the baby for any reactions or side effects. They can also advise mothers on weaning or adjusting the dose or frequency of medications to minimize the infant's exposure.

Mothers should be cautious about taking over-the-counter medications, herbal medicines, and dietary supplements, as these products may contain chemicals that can affect the baby's health. Mothers should always read the label and consult with their healthcare providers before taking any of these products while breastfeeding.

In summary, understanding the safety of medications while breastfeeding requires careful evaluation of scientific literature, communication with healthcare professionals, and consideration of individual factors and risks. Mothers should seek accurate and reliable information from trusted sources and make informed decisions about medications and breastfeeding to ensure the best outcomes for themselves and their infants.

Breastfeeding and Specific Medications

Breastfeeding mothers may have concerns about the safety of taking medications while nursing their babies. It is important for mothers to consult with their healthcare providers before taking any medications, including over-the-counter drugs, while breastfeeding.

Pain Medications

Many pain medications are safe to take while breastfeeding. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are examples of pain relievers that are considered safe for breastfeeding mothers. These medications are unlikely to harm a nursing baby when taken at recommended doses.

Cold Medications

Some cold medications are safe to take while breastfeeding, while others are not recommended. Antihistamines, such as loratadine (Claritin) and fexofenadine (Allegra), are generally considered safe for breastfeeding mothers. Decongestants, such as pseudoephedrine (Sudafed), can reduce milk supply and should be used with caution. It is important to consult with a healthcare provider before taking any cold medications while breastfeeding.

Antidepressants

Many antidepressants are safe to take while breastfeeding. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), are commonly prescribed to breastfeeding mothers. These medications are unlikely to harm a nursing baby when taken at recommended doses. However, it is important for mothers to discuss the risks and benefits of taking antidepressants while breastfeeding with their healthcare providers.

Birth Control

Breastfeeding mothers may choose to use birth control to prevent pregnancy while nursing. Progestin-only contraceptives, such as the mini-pill, are considered safe for breastfeeding mothers. Estrogen-containing contraceptives, such as combined oral contraceptives, are not recommended for breastfeeding mothers because they can reduce milk supply. It is important for mothers to discuss the risks and benefits of birth control options with their healthcare providers.

Overall, most medications are safe to take while breastfeeding. However, it is important for mothers to consult with their healthcare providers before taking any medications while nursing their babies. Mothers should also be aware of potential side effects, such as sedation or diarrhea, that may affect their babies. In some cases, surgery may be required while breastfeeding, and mothers should discuss pain management options with their healthcare providers.

Nutrition and Dietary Supplements

Proper nutrition is crucial for both the mother and the baby during breastfeeding. Breastfeeding mothers need to consume enough calories and nutrients to maintain their energy stores and produce enough milk for their baby. According to the CDC, breastfeeding mothers generally need an additional 330 to 400 kilocalories (kcal) per day, compared to their pre-pregnancy calorie intake.

A well-balanced diet that includes a variety of foods is essential for breastfeeding mothers. Protein-rich foods such as lean meat, eggs, dairy, beans, lentils, and seafood low in mercury are great choices. Whole grains, fruits, and vegetables are also important sources of nutrients. Eating a variety of foods while breastfeeding can change the flavor of breast milk, which may encourage the baby to try new foods when they are introduced later on.

Dietary supplements may also be beneficial for breastfeeding mothers. However, it is important to consult with a healthcare provider before taking any supplements. Some supplements, such as iron, vitamin D, and omega-3 fatty acids, may be recommended for breastfeeding mothers.

Breastfeeding mothers should also be aware of any dietary restrictions they may have due to their own health conditions or their baby's health. For example, if the baby has a food allergy, the mother may need to avoid certain foods to prevent an allergic reaction in the baby.

It is important to note that breast milk is the best source of nutrition for babies. While formula may be necessary in some cases, breast milk provides all the necessary nutrients for a baby's growth and development. Breastfeeding mothers should consult with a healthcare provider before supplementing with formula.

Additionally, it is important to monitor the baby's blood levels for any deficiencies or imbalances. In some cases, the baby may need to receive supplements or additional nutrients to maintain healthy blood levels.

Weaning and Milk Supply

Weaning is the process of gradually decreasing the amount of breast milk a baby receives and transitioning to other forms of nutrition. It can be a challenging and emotional time for both the mother and the baby. There are several reasons why a mother may choose to wean her baby, including returning to work, medical issues, or personal preference.

During the weaning process, it is important to maintain a healthy milk supply to prevent engorgement, plugged ducts, and mastitis. To do this, a mother can gradually reduce the number of breastfeeding sessions and replace them with bottle feedings or solid foods. It is recommended to avoid suddenly stopping breastfeeding or pumping, as this can lead to a sudden drop in milk supply.

If a mother needs to wean quickly or stop breastfeeding due to medical reasons, she may need to use a breast pump to relieve engorgement and prevent mastitis. However, if a mother needs to take medication that is not safe for breastfeeding, she may need to pump and dump her breast milk until the medication is out of her system.

It is important to note that the use of sage or other herbal remedies to decrease milk supply should be avoided, as they can be harmful and lead to other health issues. If a mother needs to wean her baby and transition to formula, it is recommended to speak with a healthcare provider to ensure the baby is receiving proper nutrition and to address any concerns or questions.

Additional Resources and Support

Breastfeeding mothers who are concerned about taking medications while breastfeeding can find additional support and resources from various organizations.

The LactMed database, maintained by the US National Library of Medicine, provides information on the effects of medications on breast milk and nursing infants. The database is regularly updated and includes information on over 1,300 drugs.

The InfantRisk Center is a call center staffed by healthcare professionals who can provide information on the safety of medications during breastfeeding. The center is run by Dr. Thomas Hale, a leading expert on medications and breastfeeding.

MommyMeds is an app and website that provides information on the safety of medications during breastfeeding. The app was developed by the Texas Tech University Health Sciences Center and is based on Dr. Hale's research.

The FDA provides information on medications and breastfeeding on its website. Breastfeeding mothers can also contact the FDA's call center for more information.

The American Academy of Pediatrics recommends that healthcare professionals consider the benefits of breastfeeding and the risks of not breastfeeding when prescribing medications to breastfeeding mothers. The organization also provides resources on breastfeeding for healthcare professionals.

The National Institutes of Health provides information on breastfeeding and medications on its website. The organization also funds research on breastfeeding and its health benefits.

The USA Breastfeeding Mission provides resources and support for breastfeeding mothers, including information on medications and breastfeeding.

The e-lactancia website, based in Spain, provides information on the safety of medications during breastfeeding. The website is available in multiple languages.

The APILAM organization, based in Spain, provides information and support for breastfeeding mothers. The organization also provides resources on medications and breastfeeding.

Breastfeeding mothers who have questions or concerns about medications and breastfeeding can also speak with their healthcare provider or contact a breastfeeding hotline for additional support.

Questions? Email Jack Newman at drjacknewman@sympatico.ca, or Edith Kernerman at breastfeeding@sympatico.ca or consult: Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA) or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding; or The Latch Book and Other Keys to Breastfeeding Success; or L-eat Latch & Transfer Tool, or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.  See our website at www.drjacknewman.com.  To make an appointment email breastfeeding@ccnm.edu and respond to the auto reply or call 416-498-0002. 

Handout You Should Continue Breastfeeding (1) (Drugs and Breastfeeding) May 2008
Written and Revised by Jack Newman, MD, FRCPC 1995-2005

  This handout may be copied and distributed without further permission,
on the condition that  it is not used in any context that violates
the International WHO Code on The Marketing of Breastmilk Substitutes