Medications To Avoid While Breastfeeding
Navigating Postpartum and Chronic Condition Medication Use
Many people believe that they shouldn’t breastfeed while taking any medications which is absolutely not true. Lots of people need to take medications while breastfeeding and the vast majority of common postpartum medications are completely fine. There are some exceptions and medications that shouldn’t be taken during breastfeeding, but they are fairly uncommonly prescribed to healthy people of childbearing age. Whether it's to manage postpartum discomfort, address health concerns, or treat chronic conditions, understanding which medications are safe during breastfeeding is crucial for the well-being of both mother and baby. This blog aims to shed light on common medications prescribed postpartum, their safety during breastfeeding, and resources for ensuring the health of your LO.
Common Postpartum Medications That Are Okay While Breastfeeding
1. Pain Relievers:
Ibuprofen (Advil, Motrin): Often prescribed for postpartum pain, ibuprofen is generally considered safe during breastfeeding. It has a low transfer rate into breast milk and is commonly recommended for pain relief.
Acetaminophen (Tylenol): Safe for nursing mothers, acetaminophen is another go-to for managing pain or fever post-delivery.
Opioid Pain Medications (Percocet, Lortab, Hydrocodone): Frequently prescribed to immediate postpartum women who have had a c-section, these are generally regarded as compatible with breastfeeding. While there is limited data on these medications during breastfeeding, when used at lower doses (<30mg/day) for short periods minimal effect on the baby is likely. It is recommended to take these right after a nursing session to limit the baby’s exposure.
2. Antibiotics:
Penicillins (Amoxicillin, Dicloxacillin) & Cephalosporins (Cephalexin): These antibiotics are usually safe during breastfeeding, with minimal concerns regarding infant exposure.
Macrolides (Erythromycin, Azithromycin): Also considered safe, though erythromycin may be associated with infantile hypertrophic pyloric stenosis if used in the first two weeks postpartum.
Nitrofurantoin (Macrobid): Often prescribed for urinary tract infections, this medication is generally considered safe during breastfeeding, but caution is recommended if the baby is experiencing jaundice.
3. Antidepressants:
SSRIs like Sertraline (Zoloft), citalopram, escitalopram, fluoxetine, etc.: Widely considered safe during breastfeeding with minimal side effects noted in infants. Breastfeeding should not stop due to the need for mental health treatment and mental health treatment should not be delayed or avoided while breastfeeding.
4. Stool Softeners:
Docusate Sodium (Colace): Generally safe and commonly used to relieve constipation postpartum. Magnesium supplements may also be used.
5. Antihypertensives:
Labetalol, Nifedipine, and Enalapril: Often prescribed for high blood pressure and considered safe during breastfeeding. However, there is some evidence that babies of mothers taking labetalol may experience low blood sugars, especially right after birth. Many hospitals will monitor this, but if you notice your baby is jittery or is too sleepy to nurse, notify your healthcare provider.
6. Anti-diabetics:
Metformin: Safe to use during breastfeeding and has been used with no untoward effects in the baby.
Insulin: Probably compatible with breastfeeding because the size of the molecule is so large that it doesn’t transfer into breastmilk in clinically significant amounts.
7. TNF Inhibitors:
Humira (Adalimumab): Sometimes prescribed for things like rheumatoid arthritis, psoriatic arthritis, ankylosis spondylitis, ulcerative colitis, and Crohn’s disease, there is only one known very small study that looked at this medication during breastfeeding, but no adverse effects were found in the two infants and both met all their milestones as expected.
Enbrel (Etanercept): Also sometimes prescribed for rheumatoid arthritis, psoriatic arthritis, and ankylosis spondylitis, this medication is considered probably safe while breastfeeding because the molecules are too large to enter the milk. In studies, the medication was not detected in infant blood levels at all.
While this list covers common medications, it's not exhaustive. The impact on lactation and the infant can vary based on dosage, frequency, and individual factors. Always discuss the medications you are taking and any concerns about them with your provider. If you prefer not to take medications, ask your provider what would happen if you didn’t take medications or if there is a natural alternative that is also safe such as dietary changes, nutrition management, over-the-counter supplements, or herbal remedies that are safe to try first.
Medications That Shouldn’t Be Taken During Breastfeeding
Only a few medications can truly not be taken during breastfeeding. In general, breastfeeding may need to be interrupted if you can’t avoid taking any of the following medications:
Chemotherapy or other anti-cancer medications
Methotrexate, sometimes used in autoimmune arthritis
Anti-acne medications like Isotretinoin, Aczone, Dapsone
Minoxidil used for hair loss
Tri-cyclic Antidepressants which are no longer commonly used
Certain anti-diabetes medications like Glimepiride, Trulicity, and Invokana
Ergot alkaloids like dihydroergotamine and ergotamine which are sometimes used to treat severe migraines
Certain radioisotopes used for nuclear medicine tests like thyroid imaging, including Iodine-131 and Iodine-123 (alternatives may be used)
Certain anti-seizure medications like phenobarbital
Drugs of Abuse: If you have an addiction to alcohol, opioid pain medications, heroin, amphetamines, cocaine, or other illegal drugs, breastfeeding should be avoided unless you are in a medication-assisted treatment (MAT) program and being monitored by a physician regularly. Marijuana should also be avoided while breastfeeding.
Resources for Medication Safety During Breastfeeding
Navigating medication safety while breastfeeding can be complex, but several resources offer reliable and up-to-date information:
LactMed Database: Part of the National Library of Medicine's TOXNET system, LactMed provides detailed information about the effects of various substances on breastfeeding mothers and infants.
InfantRisk Center: Offers up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding.
The Role of Healthcare Providers
Consulting with healthcare providers is crucial before starting or continuing any medication during breastfeeding. A healthcare provider can offer personalized advice considering the specific health circumstances and breastfeeding concerns.
Conclusion
Breastfeeding while managing postpartum recovery or chronic conditions doesn't have to be a path walked in uncertainty. By staying informed, utilizing reliable resources, and maintaining open communication with your healthcare providers, nursing mothers can navigate medication use safely and confidently.
Remember, every mother's situation is unique. While the information provided here is based on general guidelines and current knowledge, it is not an all-inclusive list and individual advice from healthcare professionals is irreplaceable.
Sources:
Moretti, M. E., Lee, A., & Ito, S. (2000). Which drugs are contraindicated during breastfeeding? Practice guidelines. Canadian Family Physician, 46, 1753-1757. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2145042/
Katrina B. Mitchell,1 Margaret M. Fleming,2 Philip O. Anderson,3 Jamie G. Giesbrandt,4 and the Academy of Breastfeeding Medicine. Breastfeeding Medicine 2019, 14(5), p290-294. DOI: 10.1089/bfm.2019.29128.kbm
Infant-Risk for Health Care Providers (version 2.0.4). [Mobile App]. Accessed on 1/17/24.
SEO Keywords:
Breastfeeding medication safety, postpartum medications, lactation drug safety, nursing mothers medication, breastfeeding and antibiotics, breastfeeding and pain relief, breastfeeding and antidepressants, medication lactation database, breastfeeding safe medications.