Healthy living

Medications and breastfeeding

While breastfeeding you may need to take medication for a few days to treat an acute illness, or on an ongoing basis to treat a chronic illness.

Breastfeeding offers you and your baby many benefits. Unfortunately, mothers are often discouraged from taking medication when breastfeeding as they are concerned that the medication will transfer through their breast milk and harm their baby.

When deciding whether to breastfeed your baby when taking medication consider:

  • the risks of the medication affecting your baby
  • the benefits of the medication to your health
  • the overall benefits that breastfeeding offers your baby.

Be safe

Only small amounts of most drugs are transferred through breast milk. The amount of the drug your baby will receive is usually very low.

You can reduce the risk of transferring medication to through your breast milk by:

  • using an alternative method of taking the drugs, such as a nasal spray instead of cold and flu tablets for a stuffy nose.
  • using the lowest appropriate dose to manage your symptoms
  • taking your medication immediately after a feed or before your baby’s longest sleep period to minimise the amount of medication in your milk
  • choosing alternative medications whenever possible
  • expressing and discarding milk if you are only taking medications for a few days.

If you are breastfeeding and taking any medication, observe your baby for drug-related side effects such as irritability, sleepiness, poor feeding or anything unusual or concerning in their behaviour.

Unsuitable medications for breastfeeding mothers

Medications which are considered unsuitable for use by breastfeeding mothers include:

  • amiodarone, used to treat heart conditions such as arrhythmia
  • cytotoxic agents, used in the treatment of cancer
  • lithium, used to treat some mental health conditions such as bipolar disorder
  • radio pharmaceuticals, used in MRI procedures
  • retinoids, used in the treatment of a number of skin conditions such as psoriasis or acne.

Commonly used medications – what to take, what to avoid

Pain medications (analgesics)

  • Ibuprofen, diclofenac, indomethacin and naproxen are considered safe to use.
  • Both paracetamol and codeine are safe alternatives, although combinations containing codeine 30 mg should be used cautiously.
  • Avoid aspirin because of the possible risk of Reye's syndrome.

Worm treatments (anthelmintics)

  • Pyrantel and mebendazole are considered safe. As they are poorly absorbed from the gastrointestinal tract, these medications are unlikely to be transferred to breast milk in large amounts.

Cold and flu medications

Body aches and pain

  • See pain medications.

Blocked, stuffy or runny nose

  • Steam inhalations and saline (sodium chloride) nasal sprays may help relieve symptoms.
  • Decongestant nasal sprays (oxymetazoline, xylometazoline) may be used.
  • Avoid medications containing pseudoephedrine as it may reduce milk production and cause your baby to become irritable.

Cough

  • Coughs often go away without treatment, but if treatment is required use:
    • guaifenesin, bromhexine or senega and ammonia mixture for a chesty cough
    • pholcodine or dextromethorphan for a dry cough.
  • Avoid medications containing pseudoephedrine as it may reduce milk production and cause your baby to become irritable.

Sore throat

  • Lozenges or throat gargles containing amylmetacresol, dichlorobenzyl alcohol or cetylpyridinium may be used.
  • Avoid products containing iodine.

Allergy and hayfever medications (antihistamines)

  • Antihistamines that make you sleepy, such as dexchlorpheniramine or diphenhydramine, may be used but watch your baby for signs of excessive sleepiness or irritability. Speak to your GP, child health nurse or call healthdirect Australia if you are concerned.
  • Antihistamines that don’t make you sleepy, such as loratadine and desloratadine, only transfer into breast milk in very small amounts and are considered safe.
  • Nasal sprays containing beclomethasone, fluticasone or budesonide may be used while breastfeeding.
  • Eye drops containing antazoline and naphazoline are considered safe to use.
  • Avoid fexofenadine and cetirizine as they have not been studied.

Infection fighting medications

These drugs can change the levels of good bacteria that live in your baby’s gut, so watch your baby for diarrhoea and thrush.

  • Penicillins (amoxycillin, flucloxacillin), cephalosporins (cephalexin), and macrolides (erythromycin and roxythromycin) are considered safe.
  • Metronidazole is considered safe in doses up to 400 mg three times a day, although it may give the milk a bitter taste. With a single high dose of metronidazole, milk should be expressed and discarded for 24 hours after the dose.

Talk to your doctor or pharmacist for further advice.

Head lice treatments

Non-insecticidal treatment (10 day hair conditioner method)

  • Apply plenty of hair conditioner to the dry hair until saturated and use an ordinary comb to remove tangles.
  • Comb hair forward, backward, left and right using a fine metal tooth nit comb.
  • Remove lice from comb.
  • Rinse out and dry hair.
  • Repeat daily for 10 days.

Insecticidal treatment

  • Permethrin, pyrethrin or piperonyl butoxide may be used. Wash off before feeding.

Antidepressants

  • Some antidepressants are considered compatible with breastfeeding. Discuss your options with your doctor or pharmacist.

Herbal preparations

  • There is very little information available on how herbal preparations transfer into breast milk or their effects on breastfeeding
  • Care should be exercised with their use.

Oral contraceptives (the pill)

  • The progesterone-only ‘minipill’ is the preferred oral contraceptive for breastfeeding women as the transfer to milk is minimal and breastfeeding is not affected.
  • The combined oestrogen-progesterone pill may decrease the quantity and alter the composition of breast milk.

Flu vaccine

  • Breastfeeding mothers may continue to breastfeed after being immunised with flu (influenza) vaccine.

More information

Contact the Obstetric Drug Information Service at the Women and Newborn Health Service for further information on the use of medications in breastfeeding mothers:

  • Phone: 9340 2723
  • Hours: 8.30am to 5.00pm Monday to Friday.

Acknowledgements
Breastfeeding Centre of WA