Most Drugs Are Safe During Breastfeeding

August 27, 2013

News Review From Harvard Medical School -- Most Drugs Are Safe During Breastfeeding

A new report from the American Academy of Pediatrics (AAP) says that nursing women can still take most necessary medications and vaccines. They don't have to stop them because of fear they may harm the baby. Many nursing women are wrongly told by their doctors to stop nursing or stop taking their medicines. In fact, only a small number of drugs need to be avoided by women who are breastfeeding. The report reviews the safety of several types of drugs, including antidepressants, pain medicines and herbal products. The AAP worked with the U.S. Food and Drug Administration on the report, which was published online in Pediatrics. HealthDay wrote about it August 27.

By Henry H. Bernstein, D.O.
Harvard Medical School

What Is the Doctor's Reaction?

Breastfeeding is wonderful. It is a natural gift from mother to baby. Many good things pass from mother to baby with breastfeeding. Unfortunately, some unwanted things, like medicine, also may end up in breast milk.

Does this mean that breastfeeding women should not take any medicine? The answer is NO! In fact, a new clinical report says that many drugs are safe to take while breastfeeding. The report was just published in the journal Pediatrics.

There is not always clear information to know when it is okay for a medicine to be used by a mother who is breastfeeding. Every drug is different. Its safety depends on things like:

• Need for the drug by the mother
• How much drug ends up in the breast milk
• How much the drug affects the amount of breast milk made
• How much drug passes into the baby’s body
• How long the drug stays in the baby’s body
• Potential side effects of the drug to the baby
• The baby’s age and health

The report reviews the safety of several drug types. The ones that raise the most concern for breastfeeding are those used for:

• Emotional troubles (psychoactive drugs)
• Helping to stop smoking, drinking or using illegal drugs
• Pain (narcotics)

The report goes on to make specific recommendations for women who are breastfeeding:

• Do not use galactalogues (things that help women make more breast milk). They do not help very much. They may not be safe for the baby.
• Do not use herbal products. These products are not proven to be safe and effective. This is different than most other drugs, which have been approved by the U.S. Food and Drug Administration (FDA). Many herbs are harmful. A few have even caused death in children.
• Stop breastfeeding for a while when you have medical imaging tests (such as X-rays). These procedures often use radiation, which is not safe for a baby.
• Get all recommended vaccines. Most are safe for mother to receive when pregnant. Vaccines protect both the mother and baby against preventable diseases. Breast milk passes mom’s antibodies that help fight infection to her baby.

What Changes Can I Make Now?

Questions about medicines and breastfeeding come up all the time. Answers may change as new studies are done. We all have lots of information at our fingertips.

Parents (and health care professionals) should refer to a new website (and application for mobile devices) from the federal government. It is called LactMed and includes:

• Up-to-date information on drug levels in breast milk and the baby
• Possible bad effects of drugs on breastfeeding infants
• Potential effects of drugs on lactation
• Possible alternative drugs to consider

Here are a few tips to make sure you are not harming your baby if you ever need to take a medicine when you are breastfeeding:

Ask your doctor about any medication you need to take. While most medicines are safe, some could be dangerous. Together, you and your doctor can decide what is best for you and your baby.

Stay away from galactalogues. There are healthier ways to make more breast milk:

• Be sure you are breastfeeding correctly.
• Try massage therapy.
• Pump milk longer.
• Express (“drain”) milk from breasts more often.
• If you are having problems breastfeeding, talk with a lactation specialist.

Avoid cigarettes, alcohol and illegal drugs.

• Smoking may reduce the amount of milk you make. It also exposes your baby to secondhand smoke, which causes many health problems.
• Alcohol and illegal drugs can pass to your baby through breast milk. These can seriously harm your baby. They can also mess up your judgment. This will make it harder for you to care for your child. While binge drinking should be avoided, small amounts of alcohol may be acceptable. 
• If you suffer from addiction to any of these substances, talk with your doctor before breastfeeding.

 What Can I Expect Looking to the Future?

You can expect doctors to continue to promote breastfeeding, even for most women who need to take medicines. The benefits of human milk will likely continue to outweigh any risks posed by medicines. As more research is done and new information on the safety of these medicines is learned, the government’s LactMed website will regularly be updated.