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 to the baby of breastfeeding 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.
The drugs 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. Both paracetamol and codeine are safe alternatives, although combinations containing codeine 30mg should be used cautiously.
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.
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 roxythromycin) 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. With a single high dose of metronidazole, milk should be expressed and discarded for 24 hours after the dose. 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.
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 Drug 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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