Medications and Breastfeeding
Experts weigh in on drugs that are safe to take while you're breastfeeding.
Needing medication is one of the most common reasons women stop breastfeeding before they planned to. But research shows that's probably unnecessary. While a few drugs can harm your baby or reduce your milk supply, a recent report from the American Academy of Pediatrics found that most are compatible with nursing. Of course, if you plan on breastfeeding, tell your baby's pediatrician about all of the medicines you're taking, including herbal products. Keep your baby safe with these guidelines.
From Meds to Milk
The rules about medication during pregnancy (when the placenta transfers substances directly into your baby's blood) don't apply to breastfeeding. "That's because a drug has to cross a number of barriers in order to get into your breast milk," says Jennifer Thomas, M.D., a breastfeeding medicine specialist at Lakeshore Medical Clinic, in Franklin, Wisconsin. "It first has to get from your bloodstream into the milk itself and then it has to be absorbed from your baby's gut into his blood in amounts high enough to have an effect." Many drugs don't weather this journey well, which means they're fine to take while nursing -- as are most drugs that are generally used to treat a baby, such as an antibiotic. Plus, if it doesn't enter your blood, like a cream, it can't enter your milk.
If you have a headache or muscle aches, it's okay to seek relief through over-the-counter or prescription medication since most won't affect your baby. Analgesics, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, reach your milk only in small amounts, says Thomas Hale, Ph.D., executive director of the InfantRisk Center at Texas Tech University Health Sciences Center, in Amarillo, and author of Medications and Mothers' Milk. Stronger painkillers, such as the opiates hydrocodone (in Vicodin) and oxycodone (in Percocet), which are used to manage pain after a vaginal delivery or cesarean section, can also be suitable if you use them as prescribed and monitor your baby.
However, you should steer clear of codeine; some bodies metabolize this drug quickly, meaning that dangerous, sometimes fatal, levels can reach your baby. Also, avoid oxycodone if possible, which can cause excessive sleepiness in infants. And be wary of aspirin, which is rarely recommended for nursing moms, and ergotamine-type migraine drugs, which can lower milk supply.
Most drugs used to treat allergies, colds, and asthma are safe to take while breastfeeding. Because asthma medications are inhaled into the lungs, they don't enter your bloodstream in great quantities and so they can't get into your milk. Decongestants have not been shown to harm nursing babies either, but the medications work by narrowing blood vessels and can therefore affect your milk supply, which depends on good blood flow. That's why antihistamines, like Benadryl, Zyrtec, and Allegra, are a better choice to treat allergies and colds, according to Carl Weiner, M.D., coauthor (with me) of The Complete Guide to Medications During Pregnancy & Breastfeeding.
If you are suffering emotionally, it's a smart move to seek out help. "We strongly urge mothers to get treatment for postpartum or chronic depression," says Dr. Hale. "Taking antidepressants is now much safer than being depressed, which can affect your ability to care for and bond with your baby." Experts say the most important consideration for treatment is sticking with a drug that works for you. The most commonly prescribed antidepressant for nursing mothers is Zoloft, because very little of it gets into breast milk. Other good choices include Lexapro and Prozac. Doctors caution that Wellbutrin may decrease your milk supply, and Celexa has been associated with drowsiness in babies.
If you're considering getting back on the Pill, you've probably heard that estrogen can inhibit milk production. That's why many ob-gyns suggest a "mini pill" with progesterone only for breastfeeding moms. But for some women, progesterone can have the same effect, says Dr. Thomas. If you're looking for a more permanent progesterone-based birth control such as Depo-Provera or the Mirena IUD, Dr. Thomas recommends starting with progesterone-only pills to see if your milk supply is affected.
Healthy Mom, Healthy Baby
Other drugs that are usually safe to take while nursing include most antibiotics, acid-reflux medications, diabetes medications, and some sleep aids. The bottom line? With so many options available, your doctor should be able to find a drug that meets your health needs -- and allows you to keep nursing until you and your baby are ready to wean, says Dr. Thomas.
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