Medicine concerns while breastfeeding

Medicine use while breastfeeding is common. You may need medicines to treat current or new health conditions during this time. There are concerns around medicine use during breastfeeding. Fortunately, many medicines have no effect on a breastfed baby and are safe to take while breastfeeding.

While most medicines pass into breast milk, the amounts are very small and don't affect the baby. Certain medicines when used while breastfeeding may cause harm or unwanted side effects in the baby. Some medicines may affect breast milk production or supply. It is important that you talk to your healthcare team before starting, stopping or changing medicines while breastfeeding.

Whether medicine affects the baby during breastfeeding depends on:

• How much of the medicine passes into the milk.
• Whether the baby absorbs the medicine.
• How much milk the baby consumes.
• The age of the baby.

Medicines and substances that are commonly asked about while breastfeeding include:

• Amphetamines.
• Benzodiazepines.
• Gabapentinoids.
• Opioids.
• Medicines used to treat opioid use disorder.
• Selective serotonin reuptake inhibitors (SSRIs).
• Triptans for migraines.
• Cannabis.
• Immunizations.
• Nicotine replacement products.

The use of any over-the-counter medicines, supplements, nonprescribed use of medicines or nicotine, cannabis, or other substances while breastfeeding should be discussed with your healthcare professional.

Amphetamines

Amphetamines are stimulants that speed up the messages between the brain and body. Some amphetamines such as dextroamphetamine (Adderall XR, Dexedrine Spansule) are prescribed to treat medical conditions such as attention-deficit/hyperactivity disorder (ADHD), narcolepsy and depression. Other amphetamines are illegal and highly addictive. This includes methamphetamine, also known as meth.

Meth should not be used while breastfeeding. Meth crosses into breast milk and can stay for more than four days after use. If you are breastfeeding, you should regularly test your urine to make sure the meth is no longer in your system. Breastfeeding should be delayed until 24 hours after a negative urine test.

Some studies have shown that prescribed amphetamine medicines when used at the right dosages do not have negative effects on breastfed infants. Your healthcare professional may recommend additional monitoring of the baby for symptoms of irritability or poor feeding. The long-term effects of amphetamine exposure on infant development are not well understood. If needed, methylphenidate (Ritalin, Concerta) may be the safest option to take for ADHD while breastfeeding.

Some studies report that amphetamines may decrease a hormone in the mother's body called prolactin. A decrease in prolactin may reduce the amount of breast milk produced. This may be more of a concern if you are taking higher doses of medicine or if you are just beginning to breastfeed. Talk with your healthcare professional about any concerns if you're taking a prescription amphetamine.

Benzodiazepines

Benzodiazepines are sedatives used to treat conditions such as anxiety, insomnia, alcohol withdrawal and seizures. They also may be used during a procedure or surgery as a part of anesthesia care. Benzodiazepines have sedative and hypnotic effects on the body that reduce anxiety and relax the muscles. As a result, benzodiazepines are often misused and can be addictive.

Benzodiazepines easily cross into breast milk. They should be used with caution while breastfeeding. The specific risks to the baby depend on the type of benzodiazepine medicine. It is important to discuss your specific medicine needs with your healthcare professional to review risks and benefits while breastfeeding. If you are taking benzodiazepines, watch your baby for decreased muscle tone, drowsiness, and breathing off and on during sleep, called apnea. Contact your healthcare professional if you notice any of these symptoms.

Gabapentinoids

Gabapentinoids are medicines used to treat seizures and nerve pain. Gabapentinoids include gabapentin (Neurontin) and pregabalin (Lyrica). These medicines also may be used to treat ongoing pain or pain after procedures.

Gabapentinoids are considered safe to use while breastfeeding. They pass into breast milk in very small amounts and the baby often has no side effects. If your baby starts to have any symptoms such as drowsiness or trouble gaining weight, talk to your healthcare professional.

Opioids

Opioids are medicines used to relieve pain. They may come from the poppy plant or can be man-made. Opioids travel through the blood and attach to receptors in the brain. This blocks pain messages and can boost feelings of pleasure. Opioids are commonly used for a short amount of time after surgery for pain control. Importantly, using opioids often and for a longer period of time can lead to dependence and addiction.

Opioids cross into breast milk. Some opioids may cause babies to become very sleepy and have trouble latching onto the nipple while breastfeeding. If you notice that your baby has increased sleepiness, trouble feeding or trouble breathing, contact your healthcare professional.

Many patients who have a cesarean birth get opioids after to help with pain. A cesarean birth, commonly known as a C-section, is a surgical procedure to deliver the baby through incisions in the abdomen and uterus. In this case, breastfeeding and opioid use is considered safe.

When opioids are needed over a longer time for ongoing pain, the lowest dose that reduces pain should be taken for the shortest possible time. Women should breastfeed before taking the medicine to reduce infant exposure.

Codeine and tramadol should be avoided as they may cause increased sleepiness and overexposure of the opioid in the baby. Heroin should be avoided due to infant risks as well as the increased risk of infectious diseases such as HIV.

Talk with your healthcare professional about opioid use while breastfeeding.

Medicines used to treat opioid use disorder

People who take opioids over a long period of time are at risk of developing opioid use disorder. Opioid use disorder is described as having cravings to use opioids, inability to control the use of opioids, and continued use despite having negative health and life-related consequences.

In some people, opioids can boost feelings of pleasure and create a sense of well-being. Once those feelings wear off, a person may take more opioids to get those feelings again. Over time, these individuals may need to take larger quantities to get the same feelings. This is how dependence starts. Opioid use disorder can lead to serious health problems, including overdose and death.

People who take medicines to treat opioid use disorder should breastfeed as long as they are not taking illicit substances. For babies who were exposed to opioids in the womb, breastfeeding while on medicines for opioid use disorder can reduce withdrawal symptoms.

Medicines for treating opioid use disorder should be continued while breastfeeding as the benefits generally outweigh risks. Discuss medicines for the treatment of opioid use disorder with your healthcare professional. Common medicines for opioid use disorder include:

• Methadone. Methadone is a long-acting opioid that reduces the effects of other opioids and reduces cravings and withdrawal symptoms. Methadone helps individuals achieve and maintain recovery. Methadone is prescribed by a certified opioid treatment program.

  Methadone enters breast milk but in amounts considered to be safe while breastfeeding. Breastfeeding is encouraged if you are stable on long-term methadone treatment. Though unlikely, if your baby shows signs of drowsiness or breathing difficulties, contact your healthcare professional. Stopping breastfeeding, when planned, should be done gradually to reduce risks of withdrawal in the infant.

• Buprenorphine. Buprenorphine has some effects of opioids but also blocks other effects of opioids. It reduces cravings and withdrawal symptoms and helps individuals achieve and maintain recovery.

  Buprenorphine is considered safe while breastfeeding because only small amounts of the medicine pass into the breast milk. Though unlikely, if you see signs of drowsiness or breathing difficulties in your baby, contact your healthcare professional. Stopping breastfeeding, when planned, should be done gradually to reduce risks of withdrawal in the infant.

• Naltrexone. Naltrexone blocks the effects of opioids and is used as a long-term medicine to treat opioid use disorder.

  Naltrexone crosses into breast milk in very small amounts but does not cause any harmful effects in the breastfed baby. If you are taking naltrexone, it is safe to continue to breastfeed.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are medicines commonly used to treat depression and anxiety. They are considered the first line treatment for depression and anxiety after birth.

While SSRIs do enter breast milk, the amount can vary depending on the medicine. In general, studies have found that breastfeeding while taking these medicines is safe. Occasionally, mild side effects can happen in the infant including irritability or poor feeding. Untreated and undertreated mental health conditions are associated with poor outcomes for people who have given birth. In general, stopping effective medicines for mental health during the postpartum period increases the risk of relapse and is not recommended.

Sertraline and paroxetine may be preferable during breastfeeding due to lower amounts in breast milk.

Triptans for migraines

Triptans are medicines used to treat headaches and migraines. They may be taken by mouth in a pill form, in a nasal spray or by injection. Sumatriptan is the most commonly used medicine.

Sumatriptan crosses into breast milk and may upset a baby's stomach. Avoiding breastfeeding for 12 hours after taking sumatriptan can help lessen the effects on a baby.

Cannabis

Cannabis is a broad term that describes products or chemical compounds that come from the cannabis plant species. It is commonly known as marijuana or weed. Tetrahydrocannabinol (THC) is the main chemical that gives the euphoric "high" feeling. Cannabis is legal in much of the United States and use may be medical or recreational. Dronabinol (Marinol) is a prescription cannabinoid typically used for managing nausea during chemotherapy.

THC enters breast milk in small quantities and can remain in the milk for 6 days to 6 weeks after use. How often and for how long cannabis is used can affect how long it can remain in breast milk. Due to the unknown effects in breastfed babies and potential exposure to other chemicals, cannabis use while breastfeeding should be avoided. Long-term outcomes are still relatively unknown, but some research shows that these chemicals may affect the baby's brain development.

Cannabis also may affect the hormone prolactin, which regulates breast milk. Frequent use may decrease the quality and amount of breast milk produced.

Immunizations

Generally, receiving immunizations while breastfeeding does not cause any problems for infants. Breastfeeding does not interfere with a baby's response to most routine infant vaccinations. In some circumstances it can enhance a baby's own immune response to their vaccinations. Breastfeeding also may reduce the chance that a baby will develop a fever after their immunizations.

Nicotine replacements

Nicotine easily crosses into breast milk. For people who smoke, cigarettes cause high levels of nicotine in breast milk and can even change the taste of breast milk. Smoking can decrease milk production and increase chances of colic in the baby. Smoking is associated with the risk of sudden infant death syndrome (SIDS). Quitting smoking is the safest option for your baby. Resources are available to support you in reaching your goals.

Nicotine replacement therapy (NRT) is the use of patches, gum, lozenges and other forms of nicotine to help people who smoke quit. While use of nicotine products isn't recommended in people who breastfeed, NRT is safer than smoking. When NRT is used, babies are exposed to less nicotine and aren't exposed to other chemicals found in cigarette smoke. Nicotine levels in NRT can vary greatly depending on the product. Shorter acting options such as gum or lozenges are favored if appropriate. Talk to your healthcare professional about the best NRT option for you while breastfeeding.

Questions to ask your healthcare professional

• Will I need to change my medicines if I want to breastfeed?
• How might this medicine affect my breast milk and my baby?
• Are there medicines and supplements I should avoid?
• Will I need to take more or less of my medicine?
• What medicines should I take when I am breastfeeding?