Which Medications Are Safe For Breastfeeding Mothers?

Breastfeeding is a crucial aspect of early infant nutrition, providing essential nutrients, antibodies, and growth factors that support the baby's health and development. It also fosters a unique bond between mother and child. However, breastfeeding can also present challenges, such as initial discomfort, concerns about milk supply, and balancing breastfeeding with other responsibilities. It provides your baby with a healthy beginning. If you require medication while you are lactating, you may wonder about its impact on your breast milk. Doctors may advise lactating mothers to avoid certain medications due to potential risks to the baby through breast milk. 

Impact of Medications on Breastfed Infants

Nearly every drug present in the bloodstream will transfer into breast milk to some degree. Most medications transfer at low levels and generally do not pose significant risks to infants. Some painkillers during breastfeeding can cause harm to the infant. However, there are exceptions where certain drugs can be found in higher concentrations in breast milk. Therefore, it is crucial to evaluate each medication individually for its potential effects during breastfeeding. Premature babies, newborns, and infants who are medically unstable or have kidney function issues are at the highest risk from exposure to medication through breast milk. Medications used in the first two days after childbirth transfer to your infant at very low levels due to the limited volume of breast milk produced during this early period. The risk is lowest for healthy babies aged 6 months and older, as their bodies metabolise drugs efficiently at this stage.

New mothers often need pain relief for a few days following childbirth, particularly after a caesarean section. During the initial days to weeks after delivery, you may experience intense, menstrual-like cramps in your uterus when your milk begins to flow, known as "letting down." This sensation is caused by your uterus contracting back to its pre-pregnancy size. Breastfeeding can lead to sore and painful breasts. There can be several other reasons why a new mother might need painkillers during pregnancy. 

Painkillers Safe to Take While Breastfeeding 

Paracetamol is recommended as the primary pain medication during breastfeeding. Although it does appear in breast milk, the amount is usually too minimal to pose any harm to your baby. Paracetamol is available as 500 mg tablets, and you can take up to two tablets four times within a 24-hour period. It is known to be a safe drug for almost everyone. 

If paracetamol alone does not adequately control a new mother’s pain, a non-steroidal anti-inflammatory drug (NSAID) can be taken as well. There are various types of anti-inflammatory pain medications, such as ibuprofen, diclofenac, and naproxen. Among them, ibuprofen is the most commonly used. It is typically taken as 400 mg, three to four times daily. Only a small amount transfers to breast milk. It is important to note that anti-inflammatory pain medications should only be taken after the birth of your baby and not during pregnancy. If you have asthma or breathing problems, stomach ulcer, reaction to aspirin or any non-steroidal anti-inflammatory drugs, kidney disease, heart disease, blood clotting disorders, or liver disease then it is advised to seek an expert opinion before consuming NSAIDs. 

If your pain is moderate to severe, you may receive a prescription for morphine sulphate in liquid form (Oramorph) to consume orally. This medication is generally administered during your hospital stay. If the pain persists at home, you may be prescribed dihydrocodeine tablets, which are also opiate painkillers. Morphine sulphate and dihydrocodeine should be used cautiously during breastfeeding. It is recommended to breastfeed before taking a dose of morphine or dihydrocodeine because some of the medication can pass into the breast milk. These medications should be taken at the lowest effective dose and for the shortest duration necessary to manage pain effectively. Large doses taken by the mother can make the breastfeeding infant sleepy and may affect feeding. 

Cold Medications Safe to Take While Breastfeeding 

Paracetamol or Acetaminophen is safe for breastfeeding mothers to beat colds. These include Tylenol and Crocin. Acetaminophen is an analgesic that can alleviate fever, inflammation, and pain. 

Dextromethorphan is another safe medication for colds while breastfeeding. However, individuals with conditions such as asthma, bronchitis, diabetes, and liver disease should avoid taking this medication as it could be harmful to their condition. 

Saline nasal drops or sprays are also considered safe. They provide relief from congestion by moisturising nasal tissues and facilitating the drainage of thick mucus. It is important to consult your doctor to ensure you use a safe brand of nasal drops or sprays that do not contain steroids.

Chlorpheniramine and Hydroxyzine are used to treat allergy-related symptoms such as stuffy, blocked, or runny nose, and may be prescribed for conditions like hay fever. They are generally considered safe for lactating mothers and babies, as only a small amount passes through breast milk. While some isolated cases of colic, drowsiness, or irritability have been observed in babies, these issues typically resolve on their own without needing medical intervention. 

Bromhexine and Guaifenesin are prescription medicines used to alleviate chesty coughs by loosening mucus through the cough reflex. They are considered safe for both the mother and child during breastfeeding, providing effective relief from congestion. 

Ibuprofen, such as Advil, is considered safe for breastfeeding infants. This cold medicine while breastfeeding transfers only in minute quantities and does not pose harm. It is effective in reducing fever. It can be used to treat conditions like flu, headaches, or colds caused by sinus infections.

Safe Antibiotics for Breastfeeding Mothers 

Most antibiotics are considered safe while breastfeeding and lower dosages are suitable for use. The list includes: 

• Amoxycillin, Amoxil 
• Azithromycin, Zithromax
• Cefaclor, Distaclor
• Cefuroxime, Zinnat
• Cephalexin, Cefalexin, Keflex
• Cephradine, Velosef
• Clarithromycin, Klaricid
• Co-amoxiclav, Augmentin
• Co-fluampicil, Flucloxacillin & Ampicillin, Magnapen
• Penicillin V, Phenoxymethyl penicillin

Medications Unsafe for Lactating Mothers 

Aspirin can lead to acidosis in babies, which reduces the kidneys' ability to maintain proper PH levels in the blood, causing increased acidity. Additionally, it can potentially cause Reye's syndrome in babies, a serious condition characterised by thinning of the blood and swelling of the liver and brain. 

Pseudoephedrine is a decongestant used to alleviate mucus buildup in the sinus and nasal passages. However, it can lower prolactin production in the mother, leading to a reduction in breast milk supply by approximately 24%. 

Decongestants that come as tablets, liquids or powders that you swallow must be avoided by breastfeeding mothers. 

Cafergot, used to treat migraines often associated with sinus congestion, should be strictly avoided during breastfeeding. It can pass through breast milk and potentially cause nausea, diarrhoea, and other adverse effects in infants. 

Xylometazoline and oxymetazoline are frequently found in nasal sprays. Due to insufficient evidence regarding their impact on breastfeeding mothers and babies, it is advised to avoid using them during breastfeeding. 

Guaifenesin is an expectorant that helps thin and loosen built-up mucus, aiding its drainage. While research on this drug's effects during breastfeeding is limited, it has been associated with the potential risk of causing hernias in babies. Hence, caution should be exercised when considering its use while breastfeeding, and consulting with a healthcare professional is advisable to weigh potential risks and benefits. 

Phenylephrine, another decongestant, can cause drowsiness in babies. It is usually not advised by doctors to consume this while lactating. 

Consulting healthcare professionals before taking any medication is crucial for breastfeeding women to ensure the safety of both themselves and their infants. Healthcare professionals can consider factors such as the mother's health condition, the baby's age and health, and any other medications the mother may be taking. They may suggest alternative treatments or adjustments in medication dosages to minimise potential risks while maintaining effective treatment for the mother. 

Frequently Asked Questions

1. Can I take painkillers during breastfeeding? 

Painkillers during breastfeeding can be consumed. Paracetamol, ibuprofen, naproxen, and codeine are generally deemed safe for breastfeeding mothers, as they transfer minimally into breast milk and pose few concerns with prolonged use. 

2. Can breastfeeding mothers take paracetamol? 

If you are breastfeeding, you can safely take standard doses of paracetamol, such as one 500mg tablet every four hours, up to four times within 24 hours. Paracetamol is recommended as the preferred pain reliever during breastfeeding because it passes into breast milk in minimal quantities.

3. What cold medicine can I take while breastfeeding? 

Paracetamol or Acetaminophen, Dextromethorphan and only some saline nasal drops or sprays that are also considered safe can be taken to beat cold while breastfeeding. Ibuprofen, such as Advil, is also considered safe while breastfeeding. 

4. Can I take Benadryl while breastfeeding?

Occasionally taking Benadryl while breastfeeding is considered safe. However, using Benadryl regularly or in large amounts may lead to potential side effects for a breastfed child. Additionally, it could potentially reduce your milk supply. 

5. What medications must be avoided while breastfeeding?

Medications like Aspirin, Pseudoephedrine, Decongestants, Cafergot, and Xylometazoline and oxymetazoline should be strictly avoided during breastfeeding. These can pass through breast milk and potentially cause nausea, diarrhoea, and other adverse effects in infants. 

6. Which medicines can disrupt breast milk supply? 

Codeine phosphate, decongestants that come as tablets, liquids or powders, some nasal decongestants that come as nose sprays or drops and aspirin for pain relief can hurt the breast milk supply. 

Sources:

Pain Relief After Birth and While Breastfeeding 

Breastfeeding and medications: What's safe? - Mayo Clinic
Use of antibiotic and analgesic drugs during lactation