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Medications to Avoid While Breastfeeding

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All new mothers, especially breast feeding mothers, have their hands full. Breastfeeding is worth the extra effort because it’s good for the baby and mother-child bonding. Many nursing mothers are relieved to be free from the many pregnancy restrictions (“don’t eat this, don’t do that”). But what many nursing mothers don’t realize is that a lot of those same rules also apply during breastfeeding. For instance, some over-the-counter and prescription drugs are linked to fetal and neonatal risk. Meaning not only can they be harmful if taken during pregnancy, but they can also pass into human breast milk and may not be safe while nursing. Also, drug exposure to a few medications can slow down the maternal milk supply, so nursing mothers should use these drugs with caution.

Please continue reading to learn more about some of the medications to avoid while breastfeeding.

What medications should be avoided when breastfeeding?

It is important for nursing mothers to be careful while taking any medications. If you are breastfeeding, you should disclose all medications to your doctor. Also, don’t forget to let your healthcare provider know before taking a new medication to ensure it does not cross over into breast milk and cause harm to the baby. Some of the medications to avoid while breastfeeding are listed below.

Aspirin

Aspirin can pass into human milk and cause a serious condition called Reye’s syndrome (also referred to as Reye-Johnson syndrome) in a nursing baby. Reye’s syndrome is associated with brain and liver damage. This condition's signs and symptoms may include infant drowsiness, irritability, vomiting, and seizures.

Opioid Analgesics

Opioids such as morphine and oxycodone are powerful pain relievers. These medications can cause serious problems in breastfed babies if a nursing mother takes them. Adverse effects of opioid exposure in a nursing infant may include infant sedation, slowed breathing, and even death. Notably, the FDA warns against the use of codeine pain and cough medicines in nursing mothers, as codeine can cause excess sleepiness, difficulty breastfeeding, and even severe breathing problems that can lead to death in breastfed infants.

Certain Antidepressants and Anti-Anxiety Medications

Many new mothers battle postpartum depression and may consider drug therapy with antidepressant medications to manage this mental health condition. Some antidepressants and anti-anxiety medications may not be safe to use while breastfeeding, so you should discuss the risks with your healthcare provider. Safer options are available, such as selective serotonin reuptake inhibitors (SSRIs) sertraline (Zoloft), and paroxetine (Paxil). 

Birth Control Pills

While the chances of getting pregnant while breastfeeding are low, nursing mothers can get pregnant. Therefore, you may want to discuss contraception with your health care provider. Some hormone birth control pills should be avoided while breastfeeding. However, there are many safe contraceptive options available to breastfeeding women, including minipill (progestin-only contraceptives), intrauterine devices (IUDs), implants (Nexplanon), and depo shots (Depo-Provera).

Beta Blockers and Antiarrhythmics 

These are medications used to treat high blood pressure and irregular heart rhythm. Some beta-blockers may not be safe for breastfeeding mothers because they can pass into breast milk, leading to infant exposure to the drug. The antiarrhythmic drug amiodarone can affect thyroid function in nursing infants.

Ergots

These drugs, for example, Cafergot (combination of ergotamine and caffeine), are used to treat migraines. They are not safe for a breastfeeding mother as they can cause vomiting, diarrhea, weak pulse, and unstable blood pressure in a nursing infant.

Epilepsy and Anti-Seizure Drugs

Certain medications used to treat epilepsy and seizures are not safe for breastfeeding moms because the maternal medication can pass into the mothers’ milk. This can result in a high infant dose, leading to adverse reactions in breastfed infants. However, it is crucial that seizures are well-managed in breastfeeding mothers, as it is essential for the well-being of moms and babies. In those cases, health professionals will  recommend rigorous monitoring of the infant serum level of the drug while closely observing the nursing infant for any worrisome symptoms.

Cancer Treatment

Mothers cannot breastfeed while receiving chemotherapy because these drugs are dangerous for nursing infants and can interfere with normal infant development.

Oral Retinoids

Retinoids (for example, tretinoin) are medications used to treat acne. While topical retinoids are safe to use by lactating women, oral retinoids (pills) should be avoided. 

Alcohol and Other Drugs

A breastfeeding mother's use of alcohol, cigarettes, marijuana, and other recreational drugs can be very dangerous for a breastfeeding infant. 

What medications affect breast milk supply?

Certain medications can suppress lactation (reduce milk production) in breastfeeding moms. Some of the medications that can decrease milk supply include:

  • Antihistamines like diphenhydramine (Benadryl) and cetirizine (Zyrtec).
  • Decongestants like pseudoephedrine (Sudafed, Claritin-D, Zyrtec-D, and Allegra-D).
  • Antihistamine and decongestant combination medications (Dimetapp).
  • Birth control pills that contain estrogen.
  • Fertility medications like clomiphene (Clomid).

Common Medications That Are Safe for Breastfeeding

Researches show that many medicines can be safely used during breastfeeding. However, you should always consult a health care provider before taking any medication. Below are some of the drug classes that are acceptable to use while breastfeeding:

Medication Tips for Breastfeeding Women

  • In general, the American Academy of Pediatrics advises that breastfeeding women only take medication when absolutely needed and at the lowest possible dose for the shortest duration.
  • If breastfeeding mothers need to take a medication short-term, they can stop nursing temporarily by “pumping and dumping” (the milk is pumped then tossed). 
  • Nursing mothers may be able to time the dose of medication to just after nursing and before the baby's most extended sleep (for example, after the last feeding before the infant’s bedtime). This should only be done with the approval of your healthcare provider.
  • Always watch your baby for side effects such as irritability, sleepiness, refusal to feed, or other known adverse effects of medication while breastfeeding. 
  • Breastfeeding mothers should avoid extended-release (ER) and long-acting (LA) formulations of medications since they remain in the body for longer. 
  • Single medications are preferable for dosing flexibility as opposed to combination medications. If you are taking a combination medication, follow the recommendations for the most problematic ingredient. An example of combination medications is Invokamet (containing metformin and canagliflozin) vs. single medication which is Invokana (canagliflozin).
  • Remember that some topical ointments applied to the breast may not be safe for the nursing infant who might come in contact with the drugs when you breastfeed. 
  • If you have a preterm (premature) infant, talk to your healthcare provider about what special precautions are needed for medications to avoid while breastfeeding. Such infants have more vulnerable organ systems than full-term infants. 
  • Precautions are not limited to prescription drugs. Many over-the-counter medications can pass into breast milk and breastfed infants or affect your milk supply. Always ask a healthcare provider before taking any medication.

 

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657301/
  2. https://www.aafp.org/afp/2001/0701/p119.html
  3. https://lacted.org/iable-breastfeeding-education-handouts/counter-medications-breastfeeding/