Which Medications Are Safe While Breastfeeding?
Small amounts of almost every medication you may take while breastfeeding will end up in your breast milk—and eventually in your nursing baby. Find out what's safe to take for relief from common ailment, and which medications are best avoided.
What’s safe? Acetaminophen and ibuprofen are both considered compatible with breastfeeding and can be taken safely to reduce minor aches and pains following childbirth. Certain long-acting nonsteroidal anti-inflammatory drugs (NSAIDS) such as naproxen (Aleve, Naprosyn) are not recommended for use longer than a few days (and even then, with some caution) and aspirin should be completely avoided.
Recovering from a Cesarean section? Stronger pain medications compatible with breastfeeding include codeine and morphine. Because higher quanitites of these two drugs can have a sedative effect on breastfeeding infants, be sure to discuss proper dosage amounts with your doctor.
What else can you do? Allow your body to heal and prevent further stress and strain by resting as much as possible during the first six weeks postpartum. Refrain from strenuous activity and enlist your partner (and other friends and relatives) to help out with household chores—especially those involving heavy lifting. If you had a C-section, reduce pressure on the incision site by placing an extra pillow against your tummy when nursing in a sitting position.
Treating Postpartum Depression
What’s safe? Very little is known about the long-term effects of antidepressants passed onto children through breast milk, and it’s important for you and your doctor to discuss the risks and benefits of these medications before beginning treatment.
Commonly prescribed antidepressants for nursing women include sertraline (Zoloft) and paroxetine (Paxil). Fluoxetine (Prozac) in breast milk has been observed to cause colic, lengthy crying, vomiting, decreased sleep, watery stools, and even coma in some infants and is therefore not recommended for mothers of babies under four months old. (Prozac can be a much safer option once Baby is between four and six months old, so Moms may begin to take it then if it’s the only antidepressant that really works for her. Be sure to talk to your doctor if you took Prozac before or during pregnancy so together you can weigh the risks and benefits.)
What else can you do? Minimize the amount of medication entering breast milk by asking your doctor to prescribe the lowest possible effective dose and by taking medications at the end of a nursing session (medication levels will have most likely peaked and begun to decline before your baby’s next feeding).
For the “baby blues,” or less severe forms of postpartum depression, consider medicine-free mood-lifting treatment alternatives such as joining a new mother’s support group and/or enrolling in a “mommy and me” exercise class. Because not enough is known about the effect of St. John’s Wort on nursing infants, breastfeeding experts caution women to avoid using this herbal remedy.
Help for Mastitis
Mastitis breast infections are usually treated through a 10- to 14-day course of antibiotics. Breastfeeding- compatible antibiotic medications include dicloxacillin (Dycill), cephalexin (Keflex), amoxicillin clavulanate (Augmentin), and erythromycin.
Antibiotics usually take effect swiftly and you should feel relief from symptoms 24 to 48 hours after starting treatment. Though you feel better, it’s important to take the entire course of medication to minimize your chances of recurrence.
What else can you do? It might be tempting to stop breastfeeding when dealing with a painful breast infection, but adequately emptying the affected breast (through pumping or nursing) helps prevent more bacteria from collecting in the breast and may even shorten the duration of the infection.
Don’t worry about your baby catching the infection—human milk’s antibacterial properties prevent infectious microbes from being passed along to your baby.
Curing Yeast Infections (Thrush)
What’s safe? One of the more commonly prescribed treatments for yeast and other fungal infections, fluconazale (Diflucan) comes in pill form and is classified as an “L2″ medication, meaning the drug has been studied in a limited number of breastfeeding women and/or the evidence of a demonstrated risk is remote. Mom taking Diflucan (so that it enters her breast milk) may help treat Baby’s thrush; an infant version of the drug is also available.
Other anti-fungal medications considered compatible with breastfeeding include the topical ointments clotrimazole (Gyne-Lotrimin), nystatin, and miconazole (Monistat). Use only as directed by your doctor.
What else can you do? Available without prescription from most drug and health food stores, gentian violet (one-percent solution in water) is a natural and safe anti-fungal treatment preferred by many nursing women in the battle against thrush. Paint the liquid on infected breasts and nipples, the inside of Baby’s mouth, and anywhere else thrush is present. Gentian violet’s dark purple color will stain the skin, but the effect is only temporary.
Soothing Cracked, Sore Nipples
What’s safe? Applying lanolin ointment or cream to your nipples after nursing can help speed the healing process by maintaining the internal moisture of the skin. Sold under the brand names Purlan and Lansinoh, 100-percent lanolin preparations are non-toxic for infants and do not need to be washed off prior to nursing.
Avoid nipple treatments made with added and/or artificial ingredients. These can further irritate the skin and make symptoms worse. Some multi-ingredient preparations may even be toxic to your baby. (In fact, recently the FDA released a warning about a nipple cream containing medications known to pose harm to an infant’s developing nervous system.)
What else can you do? Sore, cracked nipples are most likely caused by improper latch or poor positioning while breastfeeding. See out help from a lactation consultant—ask the breastfeeding specialist to observe you nurse and offer feedback on your technique. Often, only slight changes are needed to turn breastfeeding into a pain-free experience!
Treating Cold and Flu
What’s safe? As long as dosing instructions are carefully followed, most over-the-counter cold and flu remedies are classified as compatible with breastfeeding. Dextromethorphan (DXM or DM) is viewed as the safest treatment for coughs, followed by guaifenesin (Robitussin).
Nursing moms get the green light to use cough drops, but because menthol can reduce milk supply, avoid eating excessive amounts of menthol-containing lozenges. For nasal relief, look for fluticasone (Flonase), cromolyn sodium (Nasalcrom), or saline drops. Pseudoephedrine (Sudafed) may significantly decrease milk supply in some women and is best avoided. Acetaminophen can be safely used to treat fever associated with both colds and flu.
What else can you do? Reduce the need for medication by using some tried-and-true alternatives for relief of cold and flu symptoms. Sit in a steamy shower room to loosen head and chest congestion and run a warm or cool mist vaporizer at night. Drink hot water mixed with honey and lemon to sooth a sore throat, and have your partner whip up a big batch of homemade chicken soup to nourish your body’s natural ability to fight infection. And don’t forget what’s often the best medicine—lots of rest!
Help for Allergies and Asthma
What’s safe? Proceed with caution before taking over-the-counter antihistamines to treat seasonal allergies. Three commonly used allergy/congestion medications— diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), and brompheniramine (Dimetapp) —may produce sedation in some infants and increase the risk for breathing difficulties. (Though Benadryl does have a slightly higher safety rating than the others.)
Nonsedating antihistamine alternatives such as cetirizine (Zyrtec), loratadine (Claritin), and triprolidine (Actifed) are usually preferred medications for nursing women. Most inhaled steroids (i.e., Pulmicort) and bronchiodilators such as albuterol are asthma medications considered safe for use while breastfeeding.
What else can you do? When possible, opt for the nasal spray version of recommended allergy medications. Nasal antihistamine sprays are considered topical therapy and the amount of medication that ends up in your breast milk is typically much lower than if the ingested form of a medicine is used (pills or liquid suspension).
Birth Control Options
What’s safe? Contrary to the popular myth, breastfeeding is
not an effective form of birth control. Even without the return of your normal period, ovulation may occur. If you previously took birth control pills, you may opt for this form of contraception again. Nursing mothers can safely use progestin-only birth control pills (the “mini-pill”) or Depo Provera, a progesterone formula injected every three months to prevent ovulation. (Doctors won’t inject Depo Provera before Mom leaves the hospital, however, as it can interfere with milk production during a newborn’s first days. It’s best to wait until six to eight weeks postpartum to administer Depo Provera. Most women have no problems with supply with a progestin-only method like Depo Provera, but if it does create a problem, it can’t be undone. Many recommend an oral progestin pill, so if there are problems, it can be stopped.)
Avoid birth control pills containing estrogen—the powerful hormone is known to significantly decrease lactation in some women and jeopardize milk supply.
What else can you do? Because it doesn’t interfere with milk production, a diaphragm is another breastfeeding-friendly contraceptive measure. If you used this barrier method birth control before trying to conceive, you may need a new diaphragm prescribed at your six-week postpartum doctor’s visit. Pregnancy and childbirth can alter the shape of the vagina and your old diaphragm’s effectiveness might be compromised by an improper fit.
Quelling Muscle Aches and Pains
What’s safe? For breastfeeding moms feeling the strain of lifting Baby all day long, BenGay, Icy Hot, and other analgesic skin creams are generally considered safe. When it comes to topically applied pain relief, very few ingredients pass through the skin into the bloodstream.
Though no medication will likely reach your milk supply, keep creams away from the nipple area to avoid possible ingestion by your baby. Also, wash hands thoroughly after use to prevent transfer of cream to Baby’s skin.
What else can you do? If your back aches when you are breastfeeding, find a more comfortable place to sit, use a nursing pillow, put a stool under your feet, or switch to a side-lying nursing position to alleviate pain. Still hurting? Try these simple positioning switches, or contact a lactation consultant who can hone in on what’s ailing you if the pain comes from how you’re feeding.
Stopping Indigestion and Diarrhea
What’s safe? Antacids such as Tums, Rolaids, Maalox, and Mylanta are acceptable for use while breastfeeding. Nursing-friendly diarrhea remedies include Imodium and Maalox Antidiarrheal Caplets.
Medications to avoid include Alka Seltzer, Pepto Bismol, and Kaopectate: Each of these contains aspirin and/or a form of salicylate (the active ingredient in aspirin) and may put your baby at increased risk for internal bleeding and Reye Syndrome.
What else can you do? Simple measure to reduce heartburn recurrence include eating smaller meals, not eating at least two hours before bedtime, and avoiding greasy or spicy “trigger foods.”
To curb diarrhea, increase your daily servings of yogurt and other foods containing probiotics, active cultures of beneficial bacteria that help maintain intestinal balance and health.
Treatment for Skin Rashes
What’s safe? Over-the-counter antibiotic ointments and clotrimazole lotions (Lotrimin) are considered safe to use while breastfeeding. Anti-itch creams containing diphenhydramine (Benadryl) are considered “usually compatible” with breastfeeding and should only be applied as directed, with use discontinued after a few days.
Topically applied hydrocortisone can safely be used to treat eczema and other skin conditions, but do not apply hydrocortisone to the breasts and nipples. Rashes found on—or underneath—the breasts might be a sign of a yeast infection and should be checked by your doctor.
What else can you do? To treat skin rashes without medication, keep infected area clean and dry—this is often enough to help the rash resolve itself. If the rash persists or worsens after a few days, contact your doctor.
Relying on Caffeine?
What’s safe? We know how tired you are as a new mom. But caffeine rapidly appears in breast milk after drinking coffee, tea, and other caffeinated beverages. And while cup after cup may just keep you awake during the day, your baby reacts very differently to caffeine in her little body: Fussiness, jitteriness, and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes—equivalent to about 10 or more cups of coffee daily.
To minimize the effect of caffeine, cap your coffee intake at no more than two to three cups total for the day (approximately 150-400 mg of caffeine).
What else can you do? Even two to three cups of coffee might still contain more than enough caffeine to irritate your newborn’s tiny system. Try abstaining completely from caffeinated beverages and caffeine-containing foods (i.e., chocolate). If your baby’s mood and demeanor dramatically improves, you might need to consider unplugging the coffee maker (or at least switch to decaf) for the next few months.
As your baby grows in size, caffeine will be less rapidly absorbed and you will be able to gradually add your caffeine-fix back into your day. Read what Dr. Sears has to say about breastfeeding and caffeine, then use these tips to combat sleep deprivation.
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