Breastfeeding During Illness: What’s Ok to Take?

What is safe to take while breastfeeding?

       Before pregnancy and breastfeeding we all tend to have our favorite remedies, whether prescribed, over the counter (OTC), herbal, or homeopathic.  Once a new little life is physically connected to us, things change. Now we need to consider if our favorites are safe.

What questions should we ask?

       When it comes to breastfeeding we want to consider if the medicine is safe for the nursling and if it is safe for the milk supply.  Whether your nursing baby is a newborn, a nine month old, or a nursing toddler is going to matter as well. 

Do all prescribers know about medications and breastfeeding?

      Doctors, PAs, NPs, and CNMs know a great deal about the indications and cautions related to medications. Not all are experts on breastfeeding.  Not all are familiar with the ins and outs of different medications in relation to nursing. The general resources used by many providers tend to skim the surface of lactation safety.  And when you pick up a thick copy of Thomas Hale’s Medications and Mother’s Milk, it’s no wonder why.  There is a lot of information to consider!  It never hurts to seek a second opinion, especially if you feel pressured to wean earlier than desired or hear the words, “pump and dump.”

Resources

Infant Risk is an excellent resource.  During business hours you can call and ask questions from professionals who are well versed in medications and breastfeeding. This applies to prescribed as well as OTC.  Their website is informative and there is an app based on their research. Look for “MommyMeds” in your app store.

LactMed @ NIH allows you to look up a medication and see the relevant data on it.  It’s also available as an app, and it is one I use frequently. It tends to be rather technical and is related in medical-ese – which is a pro or a con depending on your preference.

A newer website to follow is The Lactation Pharmacist.  A Pharm D. and certified lactation counselor, Leslie S. has created a wonderful resource and bridges the gap for us when it comes to prescribed medications. Check her out on Facebook and Instagram, especially for Medication Monday.  

Disclaimer

     This list is by no means exhaustive!  There are many medications and home remedies out there.  As you can see by the books and websites, the list goes on and on. Please keep in mind that this is a lactation website.  It’s here for you to use for inspiration and education and is not a replacement for a visit with a trusted health care professional.  Always take into account your family’s unique health history and any allergies.

Thomas Hale’s rating system is mentioned where information is available:

L1 – compatible

L2 – limited data, probably compatible

L3 – no data, probably compatible

L4 – no data, probably hazardous

Cold, Flu, Sinus

  • Nettles – Stinging nettles are an herbal remedy for sinus and allergy issues.  There are no specific studies to establish specific effects on breastfeeding. It is well thought to be a galactagogue and source of beneficial minerals.  They can be found in a pill form or tea. Homemade infusions are also popular. The tea has quite an earthy taste, so mixing with quality local honey may be a good idea. 
  • Vitamin C – L1 – Even with large oral maternal doses, only a small increase is seen in breastmilk.  There have been no studies regarding IV doses.
  • Zinc – L2 – During lactation, zinc absorption is greater than outside of lactation .  Plasma levels seem unrelated to milk levels, indicating that zinc comes from maternal stores rather than dietary intake in order to make milk.  Avoid excessive doses while breastfeeding.
  • Oscillococcinum – a homeopathic remedy for flu-like symptoms.  There are no specific studies related to it’s affect on lactation or passage into milk. If well matched to the symptoms it is generally considered acceptable to use.  This and other homeopathic remedies are best used when the symptoms are matched well to the remedy.  Consult a Homeopath for more information.
  • Sudafed (pseudoephederine) – L3 – OTC for congestion. There is limited information, but it appears that a very small amount is actually absorbed by a nursing infant.  This medication can reduce milk supply. If the milk supply is marginal or low, it is best to avoid.
  • Phenylepherine – L3 – OTC in many cold medicines.  More popular now that psuedoephedrine has to be signed out from behind the pharmacy counter in many locations.  It is estimated that only small amounts are absorbed by nursing infants. The data is limited, though. It’s mechanism of action suggests it can reduce milk supply, though there are no studies on this topic yet. 
  • Flonase (fluticasone) – L3 – nasal spray, no specific studies available, used as directed it is unlikely to pass into the milk.
  • Afrin (oxymetazoline) – L3 – nasal spray, no specific studies available, used as directed it is unlikely to pass into the milk.  Be sure to follow package directions, as it is only meant to be used in limited doses for no more than three days in a row.
  • Benadryl (diphenhydramine) – L2 – OTC antihistamine. Small amounts reported found in milk.  This is often reported to reduce milk supply, though there have been no studies to confirm or refute this.  Use with caution in a marginal or low milk supply.  Hydrate well and use for short courses.
  • Zyrtec (certrizine) – L2 – only small amounts transfer to milk, less likely to produce sedation than other antihistamines.
  • Claritin (loratadine) – L1 – Long acting, though small amounts transfer into milk.
  • Xyzal (levoceterizine) – L2 – the active metabolite of Zyrtec (certirizine).  No studies to show effects on milk or breastfeeding.
  • Decadron (dexamethazone) – L3 – a long acting corticosteroid, this is often the “steroid shot” given at the doctor’s office.  Large doses of steroids in the same class have shown a reduction in lactation, though no studies have been performed on this particular one.   It is estimated that only a small amount actually passes through the milk.  Use caution with large doses or a low milk supply.
  • Prednisone – L2 – very small amounts pass into milk, usually lower than a therapeutic dose that would be given to a pediatric patient.  Use caution with high doses or long term use. High doses can temporarily reduce supply.

Cough

  • Dextromethorphan – L3 – no specific data, estimated that very little passes into the milk.
  • Codeine – L4 – infant deaths have been related to the maternal use of codeine while breastfeeding. Do not use.
  • Honey – has been studied to be better than placebo in reducing a cough. Ok to take while breastfeeding, just don’t feed directly to an infant under twelve months.

Sore Throat

  • Salt water gargles – no known contra-indications, simple but helpful when used consistently.
  • Honey – Ok to take while breastfeeding, just don’t feed directly to an infant under twelve months.
  • Amoxicillin – L1 – very little passes into the milk
  • Augmentin – limited data, adverse reactions are uncommon, considered acceptable for breastfeeding
  • Penicillin – L1 – limited amounts pass into milk

Nausea/Vomiting/Diarrhea

  • Pepto – Bismol – due to salicylates it is not recommended for breastfeeding.
  • Benadryl (diphenhydramine) – L2 – OTC antihistamine. Small amounts reported found in milk.  This is often reported to reduce milk supply, though there have been no studies to confirm or refute this.  Use with caution in a marginal or low milk supply.
  • Unisom/Diclegis (doxylamine/doxylamine + pyridoxine) – L3 – sleep aid often used for nausea during pregnancy.  Unknown amounts transfer into milk, adverse reactions in infants have been noted. Caution is recommended.
  • Imodium (loperamide)  – L2 – minimal amounts pass into milk.
  • Zofran (ondansetron) – L2 – no specific data on this drug. The properties of the drug indicate that little is likely to transfer into milk or inhibit lactation.
  • Phenergan (promethazine) – L3 – no specific studies, it is estimated that small amounts transfer to milk.

Pain

  • Turmeric – an anti-inflammatory spice, generally regarded as safe for general use.  There is no data regarding how much of the active compound curcumin transfers into breastmilk, or how much is safe for an infant.  However, there was a study in 2014 where turmeric, fenugreek, and ginger were given against a placebo to test for an increase in milk supply.  There weren’t any noted adverse effects from the herbs, and the combo did help to increase milk supply.   Turmeric is often used for muscle pains, headaches, and general inflammation.
  • Motrin (ibuprophen) – L1 – low relative infant dose, no effects on lactation noted.  It binds to protein and so less is found in the milk as the course of lactation goes on (as less protein is found the further post partum).
  • Tylenol (acetaminophen) – L1 – minimal amounts passed into breastmilk.
  • Toradol (ketorolac) – L2 – small amounts transferred into milk, short acting.  Well studied in neonates and infants.  
  • Hydrocodone – L3 – when used in standard doses the infant dose is minimal.  Avoid high doses for prolonged periods of time.
  • Morphine – L3 – differing studies have show different amounts of the drug passed into milk. Avoid high doses, especially with a younger infant.
  • Codeine – L4 – infant deaths have been related to the maternal use of codeine while breastfeeding. Do not use.

Sources: LactMed

Hale, Thomas, R.Ph., PH.D. (2019) Medications and Mother’s   

                Milk. New York, NY : Springer Publishing Company, LLC.

For questions about anesthesia, speak to your provider ahead of time and ask what medications can be used.  Then call Infant Risk for the specific details.  While it was standard to say “pump and dump,” new information is telling us otherwise.  The Committee on Obstetric Anesthesia has provided and insightful new statement.

Amanda is an RN, IBCLC (lactation consultant) who helps breastfeeding families through classes and home visits in the greater Baton Rouge, La area. Secure virtual visits are available for breastfeeding support no matter the location.  

All information on this website is intended for educational purposes only and should not be construed as medical advice. Magnolia Lactation Consulting encourages all families to have close communication with the medical providers of their choice.

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