Breastfeeding and Medications

General Rule Of Thumb:

If the mediation can be safely prescribed to an infant, then there is no restriction on breastfeeding when mother is taking it.


Antibiotics To Avoid:

  1. Sulfa drugs: Avoid prescribing to mother of a jaundice baby younger than 1 month of age. Avoid if baby is known to have G6PD.
  2. Erythromycin: Avoid until infant is 1 month of age. Concentration in breast milk is 10x higher.
  3. Quinolones
  4. Single high dose Flagyl
  5. Tetracycline
  6. Any antibiotic you would not prescribe to a child.

Pain Medications To Avoid:

  1. Codeine: “In rare cases, mothers can be codeine hyper-metabolizers, and this can be associated with sleepiness and apnea in breastfeeding babies.” 4
  2. Hydrocodone
  3. Oxycodone
  4. Meperidine (Demerol)
  5. Long-term use naproxen
  6. NSAID use for babies with ductal dependent lesions

Pain Medications That Are Safe:

  1. Acetaminophen
  2. Ibuprofen
  3. Morphine
  4. Hydromorphone (Dilaudid)
  5. Fentanyl

Contrast Imaging: 1
  • Radioactive compound administration may require temporary cessation of breastfeeding
  • V/Q scan – waste one feeding, 0-4 hours cessation
  • Iodinated contrast (CT) is safe and has very little concentration in breast milk, no restriction.
  • Gadolinium (MRI) is also safe  and has very little concentration in breast milk, no restriction.

Over-The-Counter Drugs:
  • Pseudoephedrine can decrease milk supply 4
  • Avoid combination products 4
  • Antihistamines may have an effect on prolactin levels. Use early in breastfeeding may need to be limited until lactation is established. Cyproheptadine is known to reduce prolactin levels and inhibit galactorrhea. 5

Psychoactive Drugs To Avoid:

Due to 10% or greater maternal plasma concentration in breast milk, the following medications are not recommended while breastfeeding. 1

  • Citalopram
  • Clomipramine
  • Diazepam
  • Fluoxetine
  • Fluvoxamine
  • Lamotrigine
  • Lithium
  • Mirtazipine
  • Nortriptyline
  • Olanzipine
  • Sertraline
  • Venlafaxine

Evidence for infant harm from breastfeeding while using drugs of abuse. 1
  • Alcohol
  • Amphetamines
  • Benzodiazepines
  • Cocaine
  • Ecstasy
  • Heroin
  • LSD
  • Methamphetamine
  • Marijuana
  • Phencyclidine

References:
  1. Sachs HC. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796-809. PubMed ; Full Text ;  Download
  2. Drugs and Lactation Database (LactMed) , National Library of Medicine (US); 2006-present. Search Site
  3. So M, Bozzo P, Inoue M, Einarson A. Safety of antihistamines during pregnancy and lactation. Can Fam Physician. 2010;56(5):427-9. Full Text
  4. Breastfeeding and Medication, American Academy of Pediatrics, Full Text
  5. Which Oral Antihistamines Are Safe To Use Whilst Breastfeeding?; UK Medicines Information pharmacists, National Health Service; March 2018,  Download

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