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Breastfeeding - medicines and drugs

breast; breastfeeding; breast feeding; drugs; medicines; medications; alcohol; cigarettes; tobacco; smoking; nicotine; marijuana; herb; herbal product ;

Lots of different things can pass from the mother’s body into the breastmilk, including things you eat and drink. It is important to be careful about medicines and check with your doctor or pharmacist, even about medicines that you buy from the chemist shop or supermarket.

Alcohol and other 'recreational' drugs such as marijuana and drugs of abuse pass easily into breast milk and can cause problems for babies.

Contents

Medicines (medications)

  • Get advice from your doctor or pharmacist about whether any medicines that you want or need to take are safe or unsafe for your breastfed baby.
  • Most medications taken by a mother will pass into breastmilk, but usually at low levels that are not harmful to the baby.
  • A few medications pass into the milk in larger amounts or are dangerous to babies. These should be avoided. Your doctor or pharmacist will be able to give you information about these and suggest alternatives when you need medication.
  • The amount of any medication in breastmilk depends on different things such as the dose, how quickly it passes into the bloodstream, and the way the medicine works.
  • If the baby is taking one medicine and the mother is taking another, the medicines might interact with each other. If the baby is not well there may be more risk if the baby gets some of your medications.
  • Some medications may cause you to make more milk, or sometimes less milk. This needs to be considered as well as the direct effect on the baby.
  • Herbal medicines or teas are not necessarily safe. Many herbs contain chemicals that can be harmful to babies.

ALERT!
If you have any questions about a medicine of any sort

  • check with your doctor or pharmacist,
  • or, in South Australia only - ring the "Drugs in Pregnancy and Lactation" information service at Women's and Children's Hospital - (08) 8161 7222 - 9am - 5 pm Monday to Friday,
  • or ring the National Medicines Line 1300 633 424 (1300 MEDICINE)  9am - 5 pm Monday to Friday (Eastern Standard Time). For more information visit www.nps.org.au

If you have an urgent concern you can ring the Poisons Information Centre 13 11 26

What you can do

  • Talk with your doctor or pharmacist, (or contact the information services listed above) before taking any medications.
  • Taking medicines for a short while is usually safer than taking them for a long time, but do not stop medicines that your doctor has recommended that you take, without checking with your doctor. Always take a full course of antibiotics for example, and don’t stop asthma preventer medication.
  • To make sure the baby gets as little as possible, try not to use over-the-counter medicines that work over a long time (long-acting).
  • Consider the age of your baby. The medicines you take may cause more problems for newborn babies than for a 9 month old baby who is having lots of different things to eat.
  • Medicines that you breathe in or rub onto your skin may be safer than injections or ones you swallow if there is a choice, because the amount of medicine in your blood is likely to be lower. The amount of medicine in breast milk is related to the amount in your blood.
  • For colds or hay fever, nose sprays are likely to be a better option than oral medicines, although most common, over-the-counter medicines are safe, especially when just 1 or 2 doses are taken. But always ask the pharmacist (chemist) to be certain they are safe. Avoid medicines with pseudoephedrine in them, as it can make babies irritable.
  • Paracetamol is the safest to use for pain, but ibuprofen is also safe. Do not use aspirin while breastfeeding.

For some medicines, take your medication straight after feeding, so the level is low again by the next feeding time. Try not to feed again for 3 or 4 hours. This does not work for all medicines. Some medicines reach their highest blood (and breastmilk) levels several hours after they are taken. Check with your doctor or pharmacist.

Stopping breastfeeding is rarely necessary. There is usually something else you can take, but some medicines that are necessary for the health of a mother can harm a breastfeeding baby, and sometimes breastfeeding cannot continue safely.

Asthma and breastfeeding

  • Good asthma control is vital if you are caring for a young baby.
  • Continue your usual medication unless your doctor advises otherwise.
  • Common inhaled asthma medications ('preventer' and 'reliever') will not harm your baby or your milk supply, but check with your doctor about the safety of any other medicines that you use.

Contraception and breastfeeding

  • Hormonal methods of contraception which contain only progesterone, such as the mini-pill, Depo-Provera** or Implanon** do not affect milk supply and the amount of hormone that passes through breastmilk to the baby is very low, and does not harm the baby. These can be started very soon after the birth of a baby.
  • Combined oral contraceptive pills may affect milk supply and are not ideal while breastfeeding.
  • Breastfeeding alone can be an effective contraceptive method
    • in the first six months after the birth of a child
    • if the baby is fully breastfed including feeding overnight so there are no long gaps between feeds
    • and if periods have not started.

      As soon as one of these three conditions changes, you are no longer protected by breastfeeding.
    • Many women have become pregnant even when fully breastfeeding, so if you really want to prevent another pregnancy, consider other contraceptive methods as well.
  • Condoms are effective barrier contraceptives, and can be a good option as they do not affect breastfeeding. Use a lubricant when you use a condom.
  • Diaphragms can be less effective than usual soon after birth because of stretching of the pelvic floor.

Antidepressants and breastfeeding

Depression is common in the early weeks and months after a baby’s birth, and medication is often recommended to help with this. However many parents worry if it can affect their baby.

  • Studies show that most antidepressants pass into breastmilk, but usually in very small amounts.
  • A few types of antidepressants have been widely used in breastfeeding mothers with no effects shown on the baby’s behaviour, development or growth when the baby is followed up some years later.
  • Some antidepressants cannot be safely taken during breastfeeding - but often other medications can be used.

As we do know that breastfeeding is good for a baby, and that having a depressed mother is not good, treating the depression while continuing breastfeeding is usually thought to be better for babies and their mothers.

If you feel really uneasy about taking medication, talk to your doctor about other treatments; some forms of counselling can sometimes work as well as medication. Herbal treatments for depression should not be used without checking with your doctor as they may not be safe.

Alcohol, tobacco and caffeine

  • Alcohol passes freely into breast milk. The level will be almost the same as in the mother's blood, and it will clear from breast milk at the same rate as it does from blood. The occasional drink is not harmful. Drinking a lot or very often can be dangerous for the baby. For more information have a look at the pamphlet developed for the Australian Breastfeeding Association 'Alcohol and breastfeeding: a guide for mothers'. 
    https://www.breastfeeding.asn.au/  
  • Cigarettes are very bad for babies regardless of whether you are breastfeeding or not.
    • Being around tobacco smoke can make a baby more likely to have colds, ear infections and chest infections.
    • Nicotine passes into breastmilk and may make a baby more irritable.
    • Nicotine also may cause decreased milk production.
    • Smoking during breastfeeds or around a baby at other times, increases the risk of the baby dying from SIDS.
    • If you need to smoke, smoke outside and immediately after feeding the baby (not just before), to lessen the effect on the baby.
    • Make sure other smokers do not smoke near your baby. Make the inside of your house, and your car, smoke-free. (In South Australia it is now illegal to smoke in a car if there are children in the car.)
  • Caffeine - more than 2 to 4 cups of coffee or tea a day, or caffeine in soft drinks, may cause a baby to be irritable and unsettled.

Marijuana and breastfeeding

  • Marijuana (or cannabis) passes in moderate amounts into the milk, although there is usually not enough for the infant to show behavioural changes at the time.
  • However marijuana does affect the baby's brain and is stored in the baby's fat for some weeks.
  • Because of the possibility of long-term effects on the developing brain it is strongly recommended that breastfeeding mothers do not smoke marijuana.
  • Marijuana may also decrease the mother's milk supply

Herbal medicines and breastfeeding

Using herbal medicines while breastfeeding may not be safe.

  • Herbal medicines are often thought to be "natural" and safe, but they are not all safe for babies.
    • Many contain chemicals that affect body functions, which is why they are used. These chemicals are not necessarily safer than those in prescription drugs.
    • Chemicals in herbs may pass into the milk like other medicines and may affect the baby.
    • Some might affect the mother's milk production.
  • Because herbal preparations are not as well controlled or tested as standard medicines, the purity and strength can vary a lot, making it hard to tell if they are safe for the baby. For most herbs we just don't know for sure.
  • We cannot recommend using most herbal products.
    • Some herbs are said to be able to increase the supply of milk. For most there is no good research to say that they do. It is possible that fenugreek may act in this way. However there have been reports of fenugreek upsetting babies.
    • Others may decrease the milk supply, for example sage is commonly used to do this, but again there is little evidence available.
    • Some common herbs may cause liver damage and need to be avoided by breastfeeding mothers. These include comfrey, coltsfoot and borage.
    • Others that may affect babies include aloe, black cohosh, feverfew, ginseng, licorice root and kavakava.
    • St John's wort (hypericum) may be an effective anti-depressant, however its effects on babies are not well known. There have been reports of increased crying or colic in babies, as well as reports of interactions with other medicines the mother may be taking. It is not recommended for breastfeeding mothers with postnatal depression.
  • Herbal products considered safe when breastfeeding (as far as we know at present) include chamomile, echinacea (short term use), fennel, garlic, elderflower and ginger.

Resources

South Australia

Parent Helpline   1300 364 100

Drugs in Lactation Service at the Women’s and Children’s Hospital – (08) 8161 7555

Your local Child and Family Health Centre - call 1300 733 606 for an appointment

Book that can be downloaded 

Women's and Children's Health Network (South Australia), "Breastfeeding your baby".  2016

Australia

Australian Breastfeeding Association
Helpline 1800 686 2 686 (1800 mum 2 mum) (24 hour service)
http://www.breastfeeding.asn.au/

International

Mother to baby (Organization of Teratology Information Specialists)  The experts behind MotherToBaby have created fact sheets that answer frequently asked questions about exposures during pregnancy and breastfeeding. 
http://www.mothertobaby.org/otis-fact-sheets-s13037  

 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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