Breastfeeding and Medications: What's Safe?

Self
Updated
Breastfeeding and medications—Understand which medications are safe to take while breastfeeding.

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

Here's what you need to know about medications and breastfeeding.

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. However, 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 metabolize drugs efficiently. Women who breastfeed more than one year after childbirth often produce relatively smaller quantities of milk. This reduces the amount of medication transferred to breast milk. Also, medications used in the first three to four days after childbirth transfer at very low levels to an infant, due to the limited volume of breast milk you're producing.

Should I stop breastfeeding while taking medication?

Most medications are safe to take while breastfeeding. Also, the benefit of continuing to take a medication for a chronic condition while breastfeeding often outweighs any potential risks.

Still, a few medications aren't safe to take while breastfeeding. If you currently take a medication that could be harmful to your baby, your health care provider might be able to recommend a safe alternative medication. Or, he or she might recommend breastfeeding when the medication is at a low level in your breast milk.

In rare cases, your health care provider might recommend that you stop breastfeeding temporarily or permanently—depending on how long you need to take the medication. If you have advanced notice, pump in addition to breastfeeding and store surplus expressed milk for use during that time. If you need to stop breastfeeding only temporarily, use a double electric breast pump to keep up your milk supply until you're able to breastfeed again. Discard the milk you pump while you're taking the medication.

If you're not sure if a medication is compatible with breastfeeding, pump, clearly label and store expressed breast milk in a separate area until you can check with your health care provider.

If you need to stop breastfeeding permanently—which is unusual—ask your health care provider about weaning and to help you choose an infant formula that will meet your baby's needs.

What medications are safe to take while breastfeeding?

With your health care provider's input, consider this list of medications found to be safe during breastfeeding. 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, )—apply minimal amount

  • Penicillins (amoxicillin, ampicillin, others)

  • Cephalosporins (Keflex)

Antihistamines

  • Loratadine (Claritin, Alavert, others)

  • Fexofenadine (Allegra)

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

New research suggests that combination birth control pills, oral contraceptives that contain estrogen and a progestin, don't affect milk production. However, further research is needed. To avoid possible interference with milk production, some experts recommend avoiding combination birth control methods during breastfeeding if possible. Otherwise, wait until breastfeeding is firmly established—about six to eight weeks—before using this type of birth control pill.

Keep in mind that combination birth control pills pose an increased risk of blood clots shortly after delivery. For otherwise healthy women, it's OK to begin using combined birth control pills and other types of combined hormonal birth control six weeks after childbirth.

Gastrointestinal medications

  • Famotidine (Pepcid)

  • Cimetidine (Tagamet HB)

Antidepressants

  • Paroxetine (Paxil)

  • Sertraline (Zoloft)

  • Fluvoxamine (Luvox)

Constipation medications

  • Docusate sodium (Colace)

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

If you plan to take medication while breastfeeding, it's always best to check with your health care provider first. Avoid taking medications that aren't necessary, such as herbal medications, high-dose vitamins, and unusual supplements.

Also ask about the timing. For example, taking medication immediately after breastfeeding 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, be sure to watch your baby for any unusual signs or symptoms—such as a change in eating or sleeping habits, fussiness, or a rash. If you notice any change in your baby's behavior, contact his or her doctor.

Updated: 2015-07-30

Publication Date: 2012-07-26