In this blog, we will explore which medications are generally safe during breastfeeding and what you need to consider when taking medications while breastfeeding.
Do All Medications Pass Into My Breast Milk?
The short answer is yes, most medications do pass into breast milk, but usually not much. The amount is determined by a variety of different medication factors:
- Molecular size (how big a medication)
- Fat solubility (how well a medication dissolves in fats or oils)
- Volume of distribution (how a drug spreads throughout the body after administration)
- Protein-binding (how a medication binds with proteins in the body)
- Timing (medication administration time relative to breastfeeding)
Many medications will only enter breast milk in tiny quantities, often below levels that would affect your baby. However, certain drugs can enter at levels that warrant more caution, particularly if they are long-acting, highly concentrated, or have the potential to affect your baby’s developing organs.
Will My Baby Be Affected by Medication in My Breast Milk?
In most cases, your baby will not be affected by small amounts of medication in your breast milk. Many medications are broken down in your body and diluted in such a way that the level your baby receives is minimal. The dose of the drug the baby receives is also dependent on how much milk your baby is consuming. For example, after 1 year, milk production typically decreases, so the dose delivered would also be low. You can read more about handling milk supply drop when sick.
However, the amount of medication your baby receives varies depending on the medication and baby’s characteristics including age, weight, and overall health which can play a role in how your baby may react to trace amounts of a medication. Some important considerations regarding your baby and how they may be impacted by medication in breast milk are below:
- Newborns, especially preterm (premature) infants, have underdeveloped livers and kidneys, making it harder for them to process drugs. They are more sensitive to certain medications:
- Medically fragile babies can have the same difficulty clearing drugs
- Older infants, on the other hand, may have a more developed ability to process drugs, reducing potential risks
Should I Stop Breastfeeding While Taking Particular Medications?
In most cases, stopping breastfeeding isn't necessary while taking medications. It is almost never necessary to stop breastfeeding, but it is advised to check every drug so that you know what to monitor for. There are a few exceptions where discontinuing breastfeeding may be recommended, but many medications are considered safe while breastfeeding with careful monitoring. Using the MommyMeds app to look at all of your medications can help you weigh any potential risks. If a medication does pose a risk, your healthcare provider may be able to suggest alternatives that are safer during breastfeeding. You can often continue breastfeeding while on medications with some minor adjustments in timing or dosage.
- InfantRisk Center Resources
- InfantRisk
- InfantRisk Call Center (1-806-352-2519) which is available to answer questions Monday through Friday 8 AM to 3 PM (central standard time)
- MommyMeds app
What Medications Can I Take While Breastfeeding?
There are many safe medicine options for common illnesses and conditions while breastfeeding. Below are responses to some of the most frequently asked questions about medications.
Medicine for Coughs and Colds While Breastfeeding
Many over-the-counter (OTC) medications for cold symptoms are generally safe during breastfeeding. Generally, it is best to avoid multi-symptom cold medicines that contain multiple active ingredients, as it’s harder to assess their safety in combination. Below are some specific medication recommendations for symptom relief for coughs and colds while breastfeeding:
- For fever and pain relief: Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are considered safe and effective
- For decongestion: saline nasal sprays or a neti pot are safe options. Pseudoephedrine (Sudafed) is usually okay in small amounts, but it may reduce milk supply in some women
- For coughs: dextromethorphan (Robitussin, Delsym) is typically considered safe while breastfeeding when used sparingly (as needed). If you use dextromethorphan, monitor your infant for sedation. Honey (for moms, not babies under 1 year) or hot tea with lemon is also a natural remedy that can provide relief.
For additional information please see the InfantRisk Center website post here regarding cough & cold medications while breastfeeding!
Medicine for Headaches While Breastfeeding
Headaches are common, especially when adjusting to the demands of new motherhood. There are many different triggers for migraine and non-medication options can be implemented to help prevent migraines including but not limited to:
- Good sleep
- Eating consistent meals and proper hydration
- Exercise
- Wearing prescription glasses to avoid eye strain
- Avoiding common dietary migraine triggers
Some patients, despite using non-medication treatments, may still need medications for managing migraines. Some options for migraine management while breastfeeding include:
- Rescue or acute therapies: acetaminophen and ibuprofen are both safe and effective pain relievers while breastfeeding (see full list here)
- Preventative therapies: propranolol, verapamil, rimegepant, amitriptyline, and venlafaxine
For additional information please see the InfantRisk Center website post here regarding migraine management in breastfeeding!
Anxiety Medication While Breastfeeding
Many moms experience heightened anxiety postpartum, and it’s important to address this if it’s affecting your well-being. If you need anxiety medication, consult your healthcare provider to ensure the safest option is chosen for your mental health and your baby’s safety.
- Serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) are considered safe during breastfeeding
- One of our recent studies on buspirone, often used for anxiety, showed minimal transfer into breast milk
Allergy Medicine While Breastfeeding
- For allergy symptoms, antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) are preferred because they are non-sedating and have minimal effects on milk supply. There is less information regarding diphenhydramine (Benadryl) so it should be avoided when possible
- Nasal steroids such as Flonase and Nasonex can be used safely while breastfeeding
Other Common Medications to Take While Breastfeeding
Medications like antibiotics, antifungals, and certain blood pressure medications are also generally safe while breastfeeding. For instance, common antibiotics such as penicillin and cephalosporins pass into breast milk in low levels. They generally provide significant maternal benefits and are unlikely to harm a baby.
If you are prescribed any medication while breastfeeding, it's always a good idea to double-check with your healthcare provider, MommyMeds, or the InfantRisk Center to ensure safety. Check out our common medications while breastfeeding guide, here.
Medicine to Avoid While Breastfeeding
While most medications are safe, there are a few that should be avoided when possible. These include:
- Chemotherapy drugs
- Stimulant ADHD medications
- Some blood thinners
- Iodine-based treatments (like radioactive iodine)
These aren’t always the end to breastfeeding, but always require extra attention. Always inform your healthcare provider that you are breastfeeding before starting a new medication to avoid unnecessary risks.
Generally, What Are the Potential Infant Side Effects of Taking Medicine While Breastfeeding?
Side effects of medications while breastfeeding is entirely dependent on the medication being used and the amount of milk your baby is consuming. As discussed above, there are multiple factors involved in how much medication gets into milk. The more medication passed into the milk, the more likely the possibility of side effects. These can include, but are not limited to:
- Mild sedation in the baby
- Fussiness or irritability
- Changes in feeding patterns
- Gastrointestinal issues, such as diarrhea or constipation
It’s important to monitor your baby for any changes when you start a new medication and report any concerns to your healthcare provider.
What If My Baby Has a Reaction to My Medicine? Will I Be Able to Tell? What Should I Do?
Premature and newborn babies are at somewhat greater risk of having an adverse event. Research suggests that over 50% of adverse events are within the first 4 weeks of age, with only around 20% of reports happening after 8 weeks of age. There are some ways to determine if your baby has reacted to a medication.
- If your baby experiences an adverse event to a medication you’re taking, you might notice changes in their behavior:
- Excessive sleepiness, irritability, or feeding difficulties.
- Gastrointestinal symptoms like vomiting or diarrhea could also indicate a reaction
- If you suspect a reaction, contact your healthcare provider immediately
In some cases, you may need to pump and discard your breast milk (known as “pumping and dumping”) until the medication clears your system. Your healthcare provider can give you guidance on when it's safe to resume breastfeeding.
General Breastfeeding Tips While Taking Medicine
- Consult your provider: Always check with your healthcare provider before taking any new prescription medications, over the counter medications, herbal medications, or complementary and alternative medications
- Timing matters: When possible, take your medication immediately after breastfeeding to minimize your baby’s exposure
- Monitor your baby: Keep an eye on your baby for any signs of a reaction, especially when starting a new medication
- Use trusted resources: The InfantRisk Center has up-to-date resources on medication safety during breastfeeding
Breastfeeding moms often face the challenge of balancing their own health needs with the safety of their babies, but with careful planning and expert guidance, you can continue breastfeeding while addressing your health concerns.
And while taking care of yourself, don't forget to use tools like a good breast pump to make your breastfeeding journey easier. The Momcozy breast pump is a great option for moms who want comfort and convenience, ensuring that you can express milk efficiently and safely. Momcozy offers a great range of breast pumps and accessories designed for convenience and comfort with additional advantages:
- Wearable
- Hands-free
- Adjustable settings
- Quiet operation
- Rechargeable batteries
- Compact/portable
- Leakproof
- Compatible with different bottles and bags
- Additional accessories such as cooling pads to help with engorgement or discomfort
By staying informed and working closely with your healthcare team, you can ensure the best outcomes for both you and your baby while managing medications during breastfeeding.
