Breastfeeding and medications: What's safe?

If you're breastfeeding, you're giving your baby a healthy start. However, if you need to take medication, you might have questions about how drugs may affect your breast milk. Here's what you need to know.

Do all medications pass into breast milk?

Almost any drug that's present in the blood will transfer into breast milk to some extent. Most medications do so at low levels and pose no real risk to most infants. There are exceptions, though. Some drugs can be found in high levels in breast milk. As a result, every medication must be considered separately.

Do infants' health and age determine how they may be affected by medication in breast milk?

Yes. Exposure to medication in breast milk poses the greatest risk to premature babies, newborns, and babies who are medically unstable or have problems with kidney function.

However, medications used in the two days after childbirth transfer at very low levels to your infant. That's because you produce a limited volume of breast milk during this time.

The risk is lowest for healthy babies 6 months and older. At this age, drugs metabolize through infants' bodies efficiently.

Should I stop breastfeeding while taking medication?

Most medications are safe to take while breastfeeding. Also, the benefit of continuing a medication for a chronic condition may outweigh any potential risks.

Still, a few medications aren't safe to take while breastfeeding. If you're taking a medication that could be harmful to your baby, your health care provider might recommend an alternative drug. Or they might recommend breastfeeding when the medication is at a low level in your breast milk.

Sometimes your health care provider might recommend that you stop breastfeeding temporarily or permanently. The recommendation can depend on how long you need to take the drug. If you know in advance, you can pump in addition to breastfeeding and store expressed milk. Then use the stored breast milk once you begin taking the drug.

If you need to stop breastfeeding only temporarily, use a double electric breast pump to keep up your milk supply until you're able to breastfeed again. Throw away the milk you pump while you're taking the medication.

If you're not sure if a medication is safe while breastfeeding, pump, label and store expressed breast milk until you check with your health care provider. If you need to stop breastfeeding permanently — which is unusual — ask your health care provider about weaning and to help you choose an infant formula.

What medications are safe to take while breastfeeding?

With your health care provider's input, consider this list of medications found to be safe during breastfeeding. Keep in mind that this isn't a full list of safe medications.

Pain relievers

• Acetaminophen (Tylenol, others)
• Ibuprofen (Advil, Motrin IB, others)
• Naproxen sodium (Aleve, Anaprox DS, others) — short-term use only

Antimicrobial medications

• Fluconazole (Diflucan)
• Miconazole (Monistat 3, Monistat 7, others) — apply minimal amount
• Clotrimazole (Mycelex, Lotrimin AF) — apply minimal amount
• Penicillins, such as amoxicillin and ampicillin
• Cephalosporins, such as cephalexin

Antihistamines

• Loratadine (Claritin, Alavert, others)
• Fexofenadine (Allegra Allergy)

Decongestants

• Medications containing pseudoephedrine (Sudafed, Zyrtec D) — use with caution because pseudoephedrine can decrease milk supply

Birth control

• Progestin-only contraceptives, also known as the minipill
• Combination contraceptives containing estrogen and progestin — discuss this option with your provider

Researchers don't have a final answer about whether combination contraceptives containing estrogen and progestin affect milk production. Talk to your health care provider before taking this type of birth control while breastfeeding.

Gastrointestinal medications

• Famotidine (Pepcid, Zantac 360)

Antidepressants

• Paroxetine (Paxil, Brisdelle, others)
• Sertraline (Zoloft)
• Fluvoxamine (Luvox)

Constipation medications

• Docusate (Colace, Phillips' Stool Softener, others)

Do I need my health care provider's OK ahead of time?

If you're breastfeeding and plan to take medication, check with your health care provider. Avoid taking medications you don't necessarily need, such as herbal medications, high-dose vitamins and unusual supplements.

Also ask about the timing. For example, taking medication immediately after breastfeeding might help lower your baby's exposure. However, different drugs peak in breast milk at different times.

What if my baby has a reaction?

When you're taking medication, watch your baby for any changes in eating or sleeping habits, fussiness, or a rash. If you notice any change in your baby's behavior, contact your child's health care provider.