Wondering about breast-feeding and medications? Know how medications can affect your breast milk and which drugs are safe to take.
By Mayo Clinic Staff
If you're breast-feeding, you know you're giving your baby a healthy start. However, if you need to take medication while you're breast-feeding, you might have questions about the possible impact on your breast milk.
Here's what you need to know about medications and breast-feeding.
Almost any drug that's present in your blood will transfer into your breast milk to some extent. However, most medications do so at low levels and pose no real risk to most infants. There are exceptions, though, in which drugs can become concentrated in breast milk. As a result, every medication must be considered separately.
Yes. Exposure to medication in breast milk poses the greatest risk to premature babies, newborns, and babies who are medically unstable or have poorly functioning kidneys.
The risk is lowest for healthy babies 6 months and older, who can metabolize drugs efficiently. Women who breast-feed more than one year after childbirth often produce relatively smaller quantities of milk. This reduces the amount of medication transferred to breast milk. Also, medications used in the first three to four days after childbirth transfer at very low levels to an infant, due to the limited volume of breast milk you're producing.
Most medications are safe to take while breast-feeding. Also, the benefit of continuing to take a medication for a chronic condition while breast-feeding often outweighs any potential risks.
Still, a few medications aren't safe to take while breast-feeding. If you currently take a medication that could be harmful to your baby, your health care provider might be able to recommend a safe alternative medication. Or, he or she might recommend breast-feeding when the medication is at a low level in your breast milk.
In rare cases, your health care provider might recommend that you stop breast-feeding temporarily or permanently — depending on how long you need to take the medication. If you have advanced notice, pump in addition to breast-feeding and store surplus expressed milk for use during that time. If you need to stop breast-feeding only temporarily, use a double electric breast pump to keep up your milk supply until you're able to breast-feed again. Discard the milk you pump while you're taking the medication.
If you're not sure if a medication is compatible with breast-feeding, pump, clearly label and store expressed breast milk in a separate area until you can check with your health care provider.
If you need to stop breast-feeding permanently — which is unusual — ask your health care provider about weaning and to help you choose an infant formula that will meet your baby's needs.
With your health care provider's input, consider this list of medications found to be safe during breast-feeding. Keep in mind that this isn't a comprehensive list of safe medications.
- Acetaminophen (Tylenol, others)
- Ibuprofen (Advil, Motrin IB, others)
- Naproxen (Naprosyn®) — short-term use only
- Fluconazole (Diflucan)
- Miconazole (Monistat 3) — apply minimal amount
- Clotrimazole (Mycelex, ) — apply minimal amount
- Penicillins (amoxicillin, ampicillin, others)
- Cephalosporins (Keflex)
- Loratadine (Claritin, Alavert, others)
- Fexofenadine (Allegra)
- Medications containing pseudoephedrine (Sudafed, Zyrtec D, others) — use with caution because pseudoephedrine can decrease milk supply
Birth control pills
- Progestin-only contraceptives, such as the minipill
New research suggests that combination birth control pills, oral contraceptives that contain estrogen and a progestin, don't affect milk production. However, further research is needed. To avoid possible interference with milk production, some experts recommend avoiding combination birth control methods during breast-feeding if possible. Otherwise, wait until breast-feeding is firmly established — about six to eight weeks — before using this type of birth control pill.
Keep in mind that combination birth control pills pose an increased risk of blood clots shortly after delivery. For otherwise healthy women, it's OK to begin using combined birth control pills and other types of combined hormonal birth control six weeks after childbirth.
- Famotidine (Pepcid)
- Cimetidine (Tagamet HB)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox)
If you plan to take medication while breast-feeding, it's always best to check with your health care provider first. Avoid taking medications that aren't necessary, such as herbal medications, high-dose vitamins and unusual supplements.
Also ask about the timing. For example, taking medication immediately after breast-feeding might help minimize your baby's exposure. However, different drugs peak in breast milk at different times.
When you're taking medication, be sure to watch your baby for any unusual signs or symptoms — such as a change in eating or sleeping habits, fussiness, or a rash. If you notice any change in your baby's behavior, contact his or her doctor.
July 30, 2015
- Tan MP, et al. Teratogen information service for pharmacists: A pilot study. Journal of Population Therapeutics and Clinical Pharmacology. 2011;18:e377.
- Henderson E, et al. Prescribing in pregnancy and during breastfeeding: Using principles in clinical practice. Postgraduate Medical Journal. 2011;87:349.
- Breastfeeding and the use of human milk. American Academy of Pediatrics Policy. http://pediatrics.aappublications.org/site/aappolicy/index.xhtml. Accessed June 26, 2015.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 92: Use of psychiatric medications during pregnancy and lactation. Obstetrics & Gynecology. 2008;111:1001. Reaffirmed 2014.
- Effect of progestin compared with combined oral contraceptive pills on lactation. Obstetrics & Gynecology. 2012;119:5.
- Briggs GG, et al. In: Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; http://www.ovid.com/site/index.jsp. Accessed June 26, 2015.
- Roy-Byrne PP. Safety of infant exposure to antidepressants and benzodiazepines through breastfeeding. http://www.uptodate.com/home. Accessed June 25, 2015.
- Wambach K, et al., eds. Drug therapy and breastfeeding. In: Breastfeeding and Human Lactation. 5th ed. Sudbury, Mass.: Jones & Bartlett Learning; 2016.
- Bahamondes L, et al. Effect of hormonal contraceptives during breastfeeding on infant's milk ingestion and growth. Fertility and Sterility. 2013;100:1.
- Sachs HC, et al. The transfer of drugs and therapeutics into human breast milk: An update on selected topics. Pediatrics. 2013;132:e796.
- Kaunitz AM. Postpartum and post abortion contraception. http://www.uptodate.com/home. Accessed June 3, 2015.
- Hale TW, et al. Medications and Mothers' Milk 2014. 16th ed. Amarillo, Texas: Hale Publishing L.P.; 2014:1.