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Medications and Breastfeeding

“I’ve just had surgery. Can I take this pain medication?”
“I have the flu. What can I take?”
“Will this cold medication make my milk dry up?”
We often receive questions about the safety of medications while breastfeeding. Families are concerned not only with how a medication might affect their baby but also how it might affect their milk supply. Fortunately, there is a great deal of information out there about medications and human milk.

Can I take medicines while nursing? 

Yes, the vast majority of prescription and over the counter medications are compatible with breastfeeding or have a breastfeeding-compatible alternative.

According to the American Academy of Pediatrics, “Only a few medications are contraindicated (not recommended) while breastfeeding. Although many medications do pass into breast milk, most have little or no effect on milk supply or on an infant’s well-being.” It is important to share that you are nursing with your healthcare provider.

Do I need to “pump and dump” while taking medications? 

Families are frequently told to “pump and “dump” when taking a medication. These recommendations are often not backed up by evidence, so it is important to check reliable sources for up-to-date research-based information.

Many health care providers rely on the package insert of the medication that they are prescribing. The package insert almost always cautions against prescribing the medication to pregnant or lactating people. However, there are many reliable resources for finding more accurate answers.

For information about whether you will need to temporarily or permanently cease breastfeeding, check with your local Leader or the resources below.

How can an LLL USA Leader help? 

Leaders are parent volunteers and not health care professionals. While Leaders are not permitted to tell you if a medication is safe, they are able to provide information about medications and possible alternatives to help you make an informed decision. Find your local LLL Leader through our Find Help! zip code search tool.

Leaders are also able to assist you in creating a pumping regimen to maintain your supply in the event that you do need to temporarily stop nursing or wean.

 

Medication Resources and Databases 

Here are a few resources that LLL USA Leaders and the families we serve have found helpful. Many are also used by medical doctors and pharmacists for assisting their patients.

LactMed

LactMed is a website database maintained by the US National Library of Medicine (NLM) at the National Institutes of Health (NIH). Both the online database and mobile app include information on the levels of 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 entries are fully referenced. A peer review panel reviews the data for scientific validity and currency.

InfantRisk

InfantRisk is a hotline, website, and mobile app that are published and maintained by Dr. Thomas Hale, a registered pharmacist, and his team at the Texas Tech University Health Sciences Center.

Hotline- Call to ask experts your questions about over the counter (OTC) or prescription medications while pregnant or nursing. Monday – Friday, 8am – 5pm CT 1-806-352-2519

InfantRisk maintains 2 mobile apps: MommyMeds for Mothers (free) and InfantRisk for Health Care Providers. The apps provide you with information about medications and both pregnancy and breastfeeding. In some cases, the apps also list possible breastfeeding-safe alternative medications.

E-Lactancia 

E-Lactancia is an Spanish-English online database maintained by APILAM, Association for Promotion of and Cultural and Scientific Research into Breastfeeding. It is maintained by both medical doctors and pharmacists.

 

What about over-the-counter (OTC) medications? 

Many parents have questions about taking over-the-counter (OTC) medications especially to treat cold and flu.

Dr. Frank J. Nice shares, “In many cases, OTC medications consist of multiple ingredients for multiple symptoms. Many OTC medicines have both regular-strength and extra-strength forms of the same product. The medication may be short-acting or long-acting. In addition, mothers may find it difficult to follow complex package directions. They may take an inappropriate OTC medication or may have been given incorrect advice by family or friends. Thus, taking an OTC medication may not be as simple as it initially appears. It will probably be even more complex for consumers who are breastfeeding.

  • Avoid taking OTC medications for which little breastfeeding information is available. A pharmacist should be able to assist with additional information.
  • Avoid taking OTC medications for which safer products are available. Once again, a pharmacist can help determine this.
  • Avoid taking combination OTCs, which are those with multiple ingredients. It is better for the mother to take an OTC that has the one or two specific ingredients that will treat her specific condition; there is no need for mothers or nurslings to be exposed to unnecessary ingredients.
  • Avoid taking extra strength forms of OTC medications. There is no need for the nursling to be exposed to extra amounts of a drug when it is not needed.
  • Avoid taking long-acting OTC medications. There is no need for the nursling to be exposed to a drug for a longer period of time, especially if an adverse reaction is possible in the nursling.”

 

What about herbal medicines or dietary supplements? 

Because of the lack of safety data, many experts including those at InfantRisk generally recommend that nursing parents avoid taking dietary supplements and herbal medicines.

In the US, the FDA only regulates the labeling of dietary supplements, not their content or quality.

Most herbals are labeled as dietary supplements, and so have to include the disclaimer that they “have not been evaluated by the Food and Drug Administration”, and are “not intended to diagnose, treat, prevent and/or cure any disease”.

The supplement manufacturer does not have to get FDA approval for its products or claims, and it does not have to prove that the product is either effective or safe.

The ingredients in herbal products often do not match what’s on the label. In a DNA study of 44 herbal products from 12 different companies, the researchers found that:

  • 59% of the samples contained plant species not listed  on the label
  • 33% of the samples contained contaminants or fillers  not listed on the label
  • 32% of the samples contained a different plant  in place of the product’s main labeled ingredient, which was NOT detected within the sample
  • 9% of the samples contained only wheat or rice,  and not the plant species on the label

For example, one of the products in the study that was labeled St. John’s Wort contained only senna, which is a laxative that should not be taken on a long-term basis. In other products, some of the unlabeled fillers and contaminants were allergens that could cause severe reactions in sensitive people.

If you are looking for information about a specific dietary supplement, some are listed in the medication resources listed above. Others can be found in this database.

If you are looking for information about herbal galactagogues to help increase your milk supply, check out the La Leche League Canada’s blog post “What is a galactagogue & why might you use one?

 

RESOURCES

Breastfeeding and Surgery, LLL USA

Over the Counter Medications and Breastfeeding, Dr. Frank Nice, RPH, DPA, CPHP for LLLI

Medications: A Quick Guide for Parents, LLLI

Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother— Academy of Breastfeeding Medicine

Cold and Flu Medications While Breastfeeding, InfantRisk

Over-The-Counter Treatments for Cough and Cold, InfantRisk

Prescription Medication Use and Breastfeeding, American Academy of Pediatrics (AAP)

Clinical Protocol #13: Contraception During Breastfeeding— Academy of Breastfeeding Medicine

Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers— Academy of Breastfeeding Medicine

Vitamin D Supplements, InfantRisk

Vitamin D, Your Baby, and You, LLLI

Vitamins and Other Nutritional Supplements, LLLI

Dietary Supplements Database, La Leche League of Virginia/West Virginia

The Nursing Mother’s Herbal by Sheila Humphrey

Nonprescription Drugs for the Breastfeeding Mother by Frank J. Nice,

 

IS YOUR CONCERN OR QUESTION NOT COVERED HERE?

Please contact a local LLL Leader with your specific questions.

Medical questions and legal questions should be directed to appropriate health care and legal professionals.

 

Page updated January 2020