Breastfeeding and medications

Breastfeeding and medications is the description of the medications that can be used by a breastfeeding mother with no or few consequences and those medications which are recommended to be avoided. Some medications are excreted in breastmilk.[1][2] Almost all medicines pass into breastmilk in small amounts. Some have no effect on the baby and can be used while breastfeeding.[3] The National Institutes of Medicine (US) maintains a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from reliable sources.[4] Some medications and herbal supplements can be of concern. This can be because the drug can accumulate in breastmilk or have effects on the infant and the mother. Those medications of concern are those medications used to treat substance and alcohol addiction. Other medications of concern are those that are used in smoking cessation. Pain medications and antidepressants need evaluation.[5]

Evaluating the potential for adverse effects

The determination of the safety of a medication can be evaluated by considering the following:

  • If and how much of the drug is present in breastmilk.[2]
  • The age and maturity of the infant. Full term infants are better able to metabolize medications than premature infants.
  • The weight of the infant.
  • The amount and percentage of breastmilk consumed by the infant. An infant taking solid foods with breastfeeding will receive a lower dose of medication.
  • The general health of the infant and the general health of the mother.
  • The nature of the mother's illness, if present.
  • The general information about the drug other literature documenting studies related to the drug and breastfeeding.
  • The duration of the drug therapy.
  • Is the drug short-acting? A short-acting form of the drug may be a better choice for a breastfeeding mother rather than a longer-acting form that stays in the mother's system for a longer period.
  • How is the medication being given?
  • Does the drug interfere with lactation?[1]

Lactation risk categories

Drugs can be categorised in one of five categories to determine how safe they are for breastfeeding:[6][7][8][9]

L1 Compatible

"Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant."[6]

L2 Probably Compatible

"Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote."[6]

L3 Probably Compatible

"There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. (New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.)"[6]

L4 Possibly Hazardous

"There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective)."[6]

L5 Hazardous

"Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant."[6]

Over the counter medications

Over the counter medications are those medications that do not require a prescription to purchase in the US. Medications that require a prescription to purchase in the US may be available in other countries without a prescription. The following guidelines are recommended:

  • taking oral medications after breastfeeding rather than before will allow some of the medication to leave the mother's body through her kidneys between nursings.
  • in most women without kidney disease, nonsteroidal anti-inflammatory drugs and paracetamol (acetaminophen) are used safely.
  • aspirin can cause rashes and even cause bleeding in infants.
  • limit the use of antihistamines for long periods of time. These anti-allergy medications can cause crying, sleep problems, fussiness, excessive sleepiness in babies. Antihistamines have an effect on the amount of milk the body produces and decrease the supply.
  • carefully observe the infant for changes or side effects when first taking a medication to watch for side effects. Side effects indicating that the medication is having an effect on the baby is difficulty breathing, rash and other questionable changes that occurred after the medication was started by the mother.
  • many times other young children are in the home and keeping these over the counter medications out of their reach is a safe practice.[10]

Other substances or chemicals have been evaluated regarding their safe use during pregnancy. Hair dye or solutions used for a 'permanent' do not pass to breastmilk. No adverse reports of using oral antihistamines and breastfeeding are found. Some of the older antihistamines used by a nursing mother can cause drowsiness in the infant. This may be a concern if the infant misses feedings by sleeping instead of nursing.[11]

References
  1. "The La Leche League InternationalI - Medications and Breastfeeding". La leche League International. Retrieved 2 August 2017.
  2. Spencer, Jeanne P.; III, Luis S. Gonzalez; Barnhart, Donna (1 July 2001). "Medications in the Breast-Feeding Mother". American Family Physician. 64 (1): 119–26. PMID 11456429.
  3. "Breastfeeding" (PDF). Office on Women’s Health, U.S. Department of Health and Human Services. 2014. Retrieved 20 July 2017. This article incorporates text from this source, which is in the public domain.
  4. "Drugs and Lactation Database (LactMed)". toxnet.nlm.nih.gov. This article incorporates text from this source, which is in the public domain.
  5. "Breastfeeding and Medication". American Association of Pediatrics. Retrieved 4 August 2017.
  6. Hale, Thomas Wright; Rowe, Hilary E. (2016-12-30). Medications and Mothers' Milk 2017 (17th ed.). New York: Springer Publishing Co Inc. ISBN 9780826128584. ASIN 0826128580.
  7. "Medications and Mothers Milk Online". www.medsmilk.com. Retrieved 2018-03-24.
  8. "Lactation Drug Risk Categories". CMBC Medical Reference. Retrieved 2018-03-24.
  9. Riordan, Jan (2005). Breastfeeding and Human Lactation. Jones & Bartlett Learning. p. 138. ISBN 9780763745851.
  10. staff, familydoctor.org editorial (1 September 2005). "OTC Medicines and Pregnancy - familydoctor.org".
  11. "Drugs in Breastmilk -Is It Safe?". The Breasfeeding Network - Britains Nonprofit Breastfeeding Support Organization. Retrieved 4 August 2017.
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