Breastfeeding and lactation: Which medicines are safe to take

An overview of medications, lactation, and breastfeeding

When it comes to medications, lactation, and breastfeeding, there are three main issues to consider:

• Does this medication lower milk production (or milk supply)?
• Does this medication pass through breast milk?
• If this medication does pass through breast milk, can the amount that passes through affect my breastfeeding baby?

When deciding whether to take medications while breastfeeding, weigh the possible benefits against the possible risks by getting answers to these questions. Other important questions to ask include:

• What am I using this medication for?
• How old is my baby?
• How much breast milk does my baby drink each day?

Is it safe to breastfeed while I’m sick?

Breastfeeding while you’re ill is generally safe, as long as you are well enough to hold your baby safely and don’t have a contagious illness or infection that could be dangerous to your baby. 

To maximize safety, wash your hands well each time you pick up your baby and before breastfeeding. You may also wear a mask while breastfeeding to avoid transferring germs.

What medicines are safe to take while breastfeeding?

Allergy medicines while breastfeeding 

If you have seasonal allergies and are breastfeeding, nasal sprays like oxymetazoline (Afrin) are a great option because they are topical medications, and very little gets absorbed into your body or your breast milk. "Nondrowsy" antihistamines that you take by mouth are also safe and include:

• cetirizine (Zyrtec)
• desloratadine (Clarinex)
• fexofenadine (Allegra)
• loratadine (Claritin)

Antihistamines that cause drowsiness like diphenhydramine (Benadryl) or chlorpheniramine could theoretically lower your milk supply, but there isn’t strong clinical evidence that this happens. If you take either of these medications along with pseudoephedrine (Sudafed) or phenylephrine (Sudafed PE), your milk production is more likely to be affected. Diphenhydramine and chlorpheniramine may also cause drowsiness and irritability in breastfed babies. Taking these medications after breastfeeding can help lower the risk of these side effects in your baby.

Cough and cold medicines and breastfeeding 

Over-the-counter (OTC) cough and cold medicines can be tricky because they often contain several ingredients. Your pediatrician or pharmacist can help you decide which OTC cough or cold medicines may be safest to take. These are the common ingredients found in cold and cough medications:

• Phenylephrine, a decongestant, may lower your milk production.
• Pseudoephedrine, a decongestant, may lower your milk production.
• Dextromethorphan, which reduces cough, is not likely to affect your baby.

Codeine is an opioid medication that treats pain and cough. Codeine and other opioids can cause drowsiness in breastfed infants. Newborns are especially sensitive to the effects of opioids in breast milk and you should work closely with your doctor and pediatrician to ensure your infant isn’t showing signs like breathing difficulties, increased sleepiness, or lethargy.

Pain and fever medicines while breastfeeding 

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are both safe to take while breastfeeding. While some of these medications do pass into breast milk, the amount is very small and the levels are typically less than a standard dose for infants. Both acetaminophen and ibuprofen are good pain relief options during breastfeeding. 

Naproxen and ibuprofen are both NSAIDs. Ibuprofen is considered more safe while breastfeeding since naproxen lasts longer in your body.

What antibiotics can you take while breastfeeding? 

Penicillin antibiotics like amoxicillin and amoxicillin-clavulanate (Augmentin) are commonly prescribed for infants and children and are safe to take while breastfeeding. 

Clindamycin (Cleocin) and metronidazole (Flagyl) are two antibiotics that can lead to diarrhea and other side effects in breastfed babies, so discuss a lactation plan with your doctor before taking these medications.

There are many more types of antibiotics and while most are safe for breastfeeding, you should talk to your prescribing provider, pediatrician, or pharmacist for information about specific antibiotics and lactation. Summer Health’s pediatricians and lactation consultants are just a text away and happy to answer your questions.

What medicines can affect milk production?

Several types of medicines can lower your milk production. Those already mentioned include the decongestants phenylephrine and pseudoephedrine. Clomiphene, a fertility medication, can lower milk supply, and so can forms of hormonal birth control that contain estrogen.

Safety tips for medications and lactation

Here are a few suggestions to follow when trying to decide whether to use a medication while breastfeeding:

• Always speak to your doctor, your child’s local pediatrician, or a Summer Health pediatrician before starting a new medication while breastfeeding. They will be able to give you specific advice about whether the medication is safe, how it may affect your milk production, and whether or how it may affect your baby.
• Ask your pharmacist. Your pharmacist is another helpful resource for information about medications and lactation.‍
• Check Lactmed for the medicine in question.Lactmed is a resource available online that includes detailed information about specific medications and lactation. Chances are, the medications you have questions about are included in this database. The “Summer of Use during Lactation” section of Lactmed will give you a summary of key information.