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Medications and breastfeeding

October 16, 2020 • read

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Medications and breastfeeding

You know not to drink or take drugs when you’re pregnant, but things get a little dicier once you’re breastfeeding. Some moms prefer to err on the side of caution and refuse to take any medications while they’re breastfeeding. But not all nursing mothers have that option. Here’s a general guide for what you need to avoid until you’re ready to wean your little one, and which medications are safe to take while breastfeeding.

How long do drugs stay in breastmilk? 

Generally most medications end up in mothers’ milk and how a baby responds will depend on how old they are and how much milk they consume. A two-week-old exclusively breastfed baby will likely be more affected than an eight-month-old who only nurses twice a day, for example. How long a drug stays in a woman’s breast milk also depends on a number of factors. Everything from how quickly her metabolism works, to what the drug is and how it is taken. This is why you should discuss every drug you take with your doctor and your child’s pediatrician.

Antibiotics & breastfeeding

We know that pregnant women shouldn’t take certain antibiotics like streptomycin because they can be dangerous to their developing fetus. The good news is that most antibiotics are safe to take while breastfeeding — even some of the antibiotics that are contraindicated for pregnant women. Some mothers do report diarrhea or thrush in their nursing children when they use certain antibiotics, however symptoms typically don’t persist beyond the treatment. In these cases, treating the mother’s issue usually outweighs the slight symptoms the child might experience.

What cold medicine can I take while breastfeeding?

It might seem like taking cold medicine while breastfeeding is a no-brainer, but it’s not. Some cold medicines contain codeine which is an opioid (pain-relieving drug). When a nursing mother takes codeine, her body turns it into morphine, which ends up in her breast milk. Nursing children whose mothers take codeine are at risk for breathing issues, a decrease in heart rate and even death, especially in their first weeks of life. Breastfeeding women should never use products containing codeine and should discuss all medication, including over-the-counter (OTC) cold medication, with their doctor and pharmacist before taking it.

Pain medication and breastfeeding

Understandably, there’s a lot of uncertainty over what pain medication is safe to take while breastfeeding, and the answer is complex. Most OTC medications like ibuprofen and acetaminophen are safe for nursing mothers to take, but many prescription pain medications aren’t. Opioid use by breastfeeding mothers, for example, can cause both sedation and respiratory distress in nursing infants. Children who are exposed to these drugs in their mother’s milk may also go through withdrawal from the opioid when they stop breastfeeding or when their mother ceases to take the drug. When given in low dosages and closely monitored by a doctor, however, it may be possible to take certain opioids safely. Mothers who give birth via caesarean section or who have an epidural during labour may receive morphine, fentanyl or remifentanil after all, all of which are powerful opioids.

Nursing and psychotropic medication

Postpartum depression and anxiety are very real risks for new parents. While not all antidepressants have studies relating to breastfeeding, most research suggests that antidepressant use while breastfeeding isn’t harmful to the child. The evidence surrounding the use of anxiety medications while breastfeeding, however, is more limited. It appears that nursing mothers may be able to take benzodiazepines (the class of medications containing anti-anxiety medication) safely as long as they watch their infants for signs of lethargy or breathing difficulties. In either case, your doctor should monitor you and your child closely. Usually, the risk of denying treatment to the nursing mother outweighs the risk to the nursing baby.

List of drugs contraindicated in breastfeeding mothers

Nursing mothers should discuss all medications, both prescription and OTC with their doctor and pharmacist before taking them. Most drugs do show up in breastmilk. And as with drinking and breastfeeding, “pumping and dumping” won’t eliminate them from your milk. As well, not all dangerous substances are taken orally. Certain beauty products such as retinoids can pose a risk to your nursing child. You should always discuss their use with a dermatologist or doctor before taking them. Here are some of the drugs that are contraindicated while breastfeeding:

Medications and breastfeeding don’t always go together, so make sure to let your doctor know if you are breastfeeding. They should be up-to-date on which ones are safe while nursing, and you can always double check your prescription using the LactMed database (they also have an app). Even though most medications you take will end up in your breastmilk, breastmilk is still the optimal source of nutrition for your child for their first two years of life. Breastfeeding mothers deserve treatment for their physical pain, illness and mental health. You don’t have to choose between treating yourself and nursing your baby.

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