The Number One Most Hated Drug Question I Get Asked

The number one most hated drug question I get asked is, “can I take this medication and breastfeed my baby?”

I usually look in a lactation reference to see if any adverse reactions have been reported or if the drug crosses into the breast milk. If there is no information on the drug other than it does cross into to the breast milk I say: “No. It crosses into the breast milk and there is no telling what it could do to your baby.” It seems like 90% of the drugs fall into this category.

That’s usually when the mother asks me again. “Are you sure?” Then I usually hear a sad story that makes me feel bad for interfering with nature and the love between a mother and her baby.

I hate that feeling. I hate being the bad guy, but if I say “yes” and her baby is harmed then I’m responsible and the baby suffers consequences.

The problem is that we don’t have a lot of lactation drug studies. There is a lot that we don’t know because no one wants to volunteer to see if the drugs harm babies, because they might.

There are some drugs I know off the top of my head that will mess up breast milk. Strong antihistamines can dry up the production of milk. When I tell mothers this they usually say, “I will suffer without that medication so I can continue to feed my baby.”

In the hospital, we prescribe life-sustaining drugs to nursing mothers who want to continue to breastfeed. One lady broke down in tears when I said no because she said she knew that was going to be her last baby and last chance to breast feed.

I know nursing mothers have high estrogen levels and are very emotional. I want to be sensitive to that fact. The mother is asking me her question for the first time, and I’m hearing it for the umpteen million time. I don’t want to be insensitive and accidentally respond with a snarky comment.

Instead I recommend pumping and dumping. This is an option for short-term drugs like antibiotic. However, in the hospital many times we are starting long-term drugs and pumping and dumping is not an option.

Pumping and dumping is when a mother formula feeds the baby while on the medications. So that her milk doesn’t dry up, we recommend that she pumps the breast milk out and throws it away. When she completes the drug treatment and the medication is out of her system, she can resume breast-feeding. I often recommend this when possible.

There is an excellent article on this topic in Pediatrics titled: "

The transfer of drugs and therapeutics into human breast milk: an update on selected topics,"

for anyone wanting to know more on the subject and to possibly diffuse the stress of answering this question.¹

Drugs that are considered safe to take when breastfeeding. (This information can be found in any drug reference book.)

Acetaminophen

Acyclovir and valacyclovir

Antacids (Maalox, Mylanta)

Bupivacaine

Caffeine (up to 3 drinks/day) - (coffee, soft drinks)

Cephalosporins (Keflex, Ceclor, Ceftin, Omnicef, Suprax)

Clotrimazole (Lotrimin, Mycelex)

Contraceptives (progestin-only) - (Micronor, Norplant, Depo-Provera)

Corticosteroids (Prednisone)

Decongestant nasal sprays (Afrin)

Digoxin

Erythromycin

Fexofenadine

Fluconazole

Heparin

Ibuprofen

Inhalers, bronchodilators, and corticosteroids

Insulin

Laxatives, bulk-forming and stool softening(Metamucil, Colace)

Lidocaine

Loratadine

Low molecular weight heparins (enoxaparin)

Anticoagulants

Magnesium sulfate

Methyldopa

Methylergonovine (short courses)

Metoprolol

Miconazole (Monistat 3)

Nifedipine

Penicillins (Amoxicillin, Dynapen)

Propranolol

Theophylline

Tretinoin (Retin A)

Thyroid replacement (Synthroid)

Used to treat thyroid problems

Vaccines (except smallpox and yellow fever)

Vancomycin

Verapamil

Warfarin

Reference

1.

Hari, Cheryl Sachs and Committee on Drugs. 2013. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 132(3):e796-809.

http://dx.doi.org/10.1542/peds.2013-1985

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