The short answer is – it depends on the medication.
If you are planning on, or currently are, breastfeeding and need to take a prescription medication, you probably wonder whether the medication could harm your baby. Most medications present in your blood will also be present, to some degree, in your breast milk. However, usually the levels of medication in your breast milk are low and do not pose a risk to your baby.
It is important to note that there are medications that do concentrate in harmful amounts in breast milk. For example, lithium, cytotoxic agents, retinoids, or radiopharmaceuticals should be avoided if you are breastfeeding.
Another factor to consider is the health and age of the baby. The effects of a medication may be more severe on babies that are premature, newborn, with poorly functioning kidneys, or medically unstable. The risk is lower in babies that are aged 6 months or older, since at this age they can already metabolize drugs more efficiently. Another factor to consider is the amount of milk your breasts are making. In the first few days after birth, most women will produce a limited volume of milk and women who breastfeed for more than one year tend to produce a smaller volume of milk.
Although most medications are safe to use while breastfeeding, you should always discuss them with your healthcare provider. If a medication is not safe to your baby, your provider may be able to recommend either an alternative medication or a time to breastfeed when the medication is at a low concentration in your breast milk. Occasionally, your doctor may recommend stopping breastfeeding, but this is uncommon.
In addition to medications, you should also discuss with your healthcare provider any supplements, vitamins, or herbal medications you are taking, as some of these may not be safe while breastfeeding.
Which medications are safe to take while breastfeeding?
Although this list is not comprehensive, here are some medications that are considered to be safe while you are breastfeeding (note: always consult with your doctor before taking any prescription medication):
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox)
- Loratidine (Claritin, Alavert)
- Fexofenadine (Allegra)
- Cephalosporins (Keflex)
- Clotrimazole (Mycelex) – use minimal amount possible
- Flucanozole (Diflucan)
- Miconazole (Monistat 3) – use minimal amount possible
- Flucloxacillin etc
Birth control pills:
- Progestin-only contraceptives, such as the minipill*
- Docusate sodium (Colace)
- Medications containing pseudoephedrine are safe (such as Sudafed, Zyrtec D) but use with caution as pseudoephedrine can decrease your milk supply
- Famotidine (Pepcid)
- Cimetidine (Tagamet HB)
If you are taking a medication that does not appear on this list and, for some reason you will not see your healthcare provider in the near future, this is a great website from the US National Library of Medicine to check whether the drug you are taking is safe during breastfeeding: https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm.
Monitor your baby for signs of a reaction
If you take a medication while breastfeeding, be sure to observe your baby for any unusual symptoms or signs, such as fussiness, rash, or change in eating or sleeping habits. If you notice any changes like these, or other changes, contact your pediatrician.
*New research suggests that combination birth control pills do not affect milk production; however, more research is needed. Therefore, avoid combination birth control medications while breastfeeding. If this is not possible, wait for 6–8 weeks, until breastfeeding is firmly established.