The advantages of breastfeeding for both a mother and her baby are well known. Many nursing mothers may need to be treated with drugs, either for a chronic illness requiring ongoing therapy or for an acute illness requiring only a few days therapy. Unfortunately, nursing mothers are often discouraged from breastfeeding by the belief that the suckling child will suffer adverse effects from the drugs in the milk. Often this belief is based on inadequate or speculative information relating to the passage of the drug into the breast milk, and the effects on the infant.
The safety of breastfeeding while a mother is taking medication may be assessed by weighing the risks of adverse effects occurring in the baby due to the drug, against the beneficial effects of the drug for the mother. The benefits of breastfeeding to the baby must also be considered.
Methods of minimising drug transfer to the infant include:
Most drugs are transferred to breast milk only in small amounts and the dose to which the infant is exposed is very low and well below the therapeutic dose for an infant. However, all infants exposed to drugs via breast milk should be observed for drug-related side effects. Drugs which are considered unsuitable for use by breastfeeding mothers include: amiodarone, cytotoxic agents, lithium, radio pharmaceuticals, and retinoids.
Ibuprofen, diclofenac, indomethacin and naproxen have an acceptably low infant dose and are considered safe to use. Aspirin is contraindicated only because of the theoretical risk of Reye’s syndrome. Paracetamol can be used safely during breastfeeding.
Medications containing Codeine
Medications containing codeine are no longer routinely recommended for long term pain relief in breastfeeding mothers. Codeine metabolises to morphine in the body, higher than expected serum and breastmilk morphine levels can occur in a small number of people who rapidly convert codeine to morphine resulting in an increased risk of transfer to the infant via the breastmilk. When required, codeine doses should be used cautiously and limited to the lowest effective dose for the shortest period of time with close monitoring of the infant. If the infant shows any signs of increased sleepiness (more than usual), or difficulty breastfeeding , the medication should be stopped and a doctor contacted immediately. The breastfeeding mother should consider alternative pain control medicines as mentioned above.
Pyrantel and mebendazole are considered safe as they are poorly absorbed from the gastrointestinal tract and are unlikely to be transferred to breast milk in clinically significant amounts.
Non-sedating antihistamines such as; loratadine, desloratadine and fexofenadine are transferred into breast milk in very small amounts and are considered safe to use whilst breastfeeding. Sedating antihistamines such as cetirizine, dexchlorpheniramine or diphenhydramine may be used as occasional doses but the baby should be observed for sedation or irritability.
Nasal sprays containing beclomethasone, fluticasone or budesonide may be used while breastfeeding. Eye drops containing antazoline and naphazoline are considered safe to use.
In general, these drugs have the potential to cause changes in bowel flora and infants should be observed for adverse gastrointestinal effects such as diarrhoea and thrush. Penicillins (amoxycillin, flucloxacillin), cephalosporins (cephalexin), and macrolides (erythromycin and azithromycin) are considered safe. Metronidazole is considered safe in doses up to 400mg three times a day, although it may give the milk a bitter taste. Talk to your doctor or pharmacist for further advice.
Some antidepressants are considered compatible with breastfeeding. Talk to your doctor or pharmacist to discuss your options and for further advice.
There is very little information available on the distribution of herbal preparations into breast milk, or their effects on lactation. Care should be exercised with their use. Talk to your doctor or pharmacist to discuss your options and for further advice.
The progesterone-only “minipill” is the preferred oral contraceptive for breastfeeding women as transfer to milk is minimal and lactation is not affected. The combined oestrogen-progesterone pill may decrease the quantity and alter the composition of milk.
Breastfeeding mothers may continue to breastfeed after immunisation with flu (influenza) vaccine.
The Obstetric Medicines Information Service at the Women and Newborn Health Service can provide further information on the use of drugs in breastfeeding mothers. The service operates from 8:30am to 5:00pm on weekdays and can be contacted on telephone (08) 9340 2723.
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