Breast-feeding and medications: What's safe?

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're giving your baby a healthy start. However, if you need to take medication, you might have questions about the possible impact on your breast milk. Here's what you need to know.

Do all medications pass into breast milk?

Almost any drug that's present in your blood will transfer into your breast milk to some extent. 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.

Does my baby's health and age influence how he or she might be affected by exposure to medication in my breast milk?

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 move drugs through their bodies efficiently. Women who breast-feed more than one year after childbirth often make relatively smaller quantities of milk. This reduces the amount of medication transferred to breast milk. Also, medications used in the two days after childbirth transfer at very low levels to your infant due to the limited volume of breast milk you produce during this time.

Should I stop breast-feeding while taking medication?

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're taking a medication that could be harmful to your baby, your health care provider might recommend an alternative medication. Or he or she might recommend breast-feeding when the medication is at a low level in your breast milk.

Sometimes 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 advance notice, pump in addition to breast-feeding and store 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, label and store expressed breast milk in a separate area until you 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.

What medications are safe to take while breast-feeding?

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.

Pain relievers

  • Acetaminophen (Tylenol, others)
  • Ibuprofen (Advil, Motrin IB, others)
  • Naproxen (Naprosyn) — short-term use only

Antimicrobial medications

  • Fluconazole (Diflucan)
  • Miconazole (Monistat 3) — apply minimal amount
  • Clotrimazole (Mycelex, Lotrimin) — apply minimal amount
  • Penicillins, such as amoxicillin and ampicillin
  • Cephalosporins, such as cephalexin (Keflex)

Antihistamines

  • Loratadine (Claritin, Alavert, others)
  • Fexofenadine (Allegra Allergy)

Decongestants

  • 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

Recent research suggests that birth control methods that use both estrogen and progestin — such as combined birth control pills — don't affect milk production. For otherwise healthy women, it's OK to begin using combined birth control pills and other types of combined hormonal birth control one month after childbirth.

Gastrointestinal medications

  • Famotidine (Pepcid)
  • Cimetidine (Tagamet HB)

Antidepressants

  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Fluvoxamine (Luvox)

Constipation medications

  • Docusate sodium (Colace, Diocto)

Do I need my health care provider's OK ahead of time?

If you're breast-feeding and plan to take medication, check with your health care provider. Avoid taking unnecessary medications, 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.

What if my baby has a reaction?

When you're taking medication, watch your baby for any changes in eating or sleeping habits, fussiness, or a rash. If you notice any change in your baby's behavior, contact his or her doctor.

Nov. 28, 2018 See more In-depth