Breastfeeding and medications: What's safe?

If you're breastfeeding, you're giving your baby a healthy start. But if you need to take medicine, you might have questions about how it may affect your breast milk. Here's what may be helpful to know.

Do all medicines pass into breast milk?

Almost any medicine you take by mouth goes into your breast milk. Most of the time this is a tiny amount that's not likely to be a risk to your baby. But there are exceptions. Some medicines can be found in high levels in breast milk. It's important to talk with your healthcare professional about each medicine and supplement you take.

Do infants' health and age affect how medicines in breast milk may affect them?

Yes. Exposure to medicine in breast milk poses the highest risk to premature babies, newborns, and babies who have many kidney or other health issues.

But medicines used in the first 3 to 4 days after childbirth transfer at very low levels to your infant. That's because you don't usually make a lot of breast milk during this time.

The risk is lowest for babies who are 6 months or older and don't have health concerns. At this age, an infant's body is better able to break down the medicines in breast milk.

Should I stop breastfeeding while taking medicine?

Most medicines are safe to take while breastfeeding. If you take medicine for an ongoing health condition, it's important that you can take your medicine to stay healthy.

Still, a few medicines aren't safe to take while breastfeeding. If you're taking a medicine that could be harmful to your baby, your healthcare professional might suggest another option. Or your health professional might suggest that you take the medicine right after breastfeeding. This can help make sure the smallest possible amount is in your breast milk at the next feeding.

Sometimes your healthcare professional might suggest that you stop breastfeeding for a short time or altogether. This may depend on how long you need to take the medicine. Some people may pump their breast milk before they start taking a medicine. If you do this, you can store the extra milk and give it to your baby when you're taking the medicine.

If you need to stop breastfeeding for a short time, think about using an electric breast pump that pumps both breasts at the same time, called a double electric breast pump. This type of pump can help you keep up your milk supply until you're able to breastfeed again. Throw away the milk you pump while you're taking the medicine.

If you're not sure whether a medicine is safe while breastfeeding, you can pump, label and store the pumped breast milk until you check with your healthcare professional. It's rare, but sometimes you may need to stop breastfeeding. Your healthcare professional can help you choose an infant formula or find a source for donor human milk.

What medicines are safe to take while breastfeeding?

With your healthcare professional's feedback, you may be able to take medicines in this list that have been found to be safe during breastfeeding. Keep in mind that this isn't a full list of safe medicines.

Pain relievers

• Acetaminophen (Tylenol, others)
• Ibuprofen (Advil, Motrin IB, others)

Antimicrobial medications

• Miconazole (Monistat 3, M-Zole 3, others).
• Fluconazole (Diflucan).
• Clotrimazole (Mycelex, Lotrimin AF, Trivagizole 3), but apply the smallest amount needed when using on the skin.
• Penicillins, such as amoxicillin, penicillin and ampicillin.
• Cephalosporins, such as cephalexin.

Nasal allergy medicines

• Fluticasone (Flonase Allergy Relief, Flovent HFA, others).
• Budesonide (Rhinocort Allergy, Pulmicort Flexhaler, others).

Antihistamines

• Cetirizine (Zyrtec Allergy, Xyzal Allergy 24HR, others).
• Loratadine (Claritin, Alavert, others).
• Fexofenadine (Allegra Allergy).

Decongestants

• Medicines that contain pseudoephedrine (Sudafed 24 Hour, Zyrtec-D 12 Hour, others) may lessen milk supply. You may wish to try saline nasal drops, a nasal spray or a humidifier instead.

Birth control

• Intrauterine contraceptives levonorgestrel (Mirena, Liletta, others) and copper (Miudella, Paragard, others).
• Contraceptive implant etonogestrel (Nexplanon).
• Progestin-only contraceptive pills also called minipills: norgestrel (Opill), norethindrone (Errin, Nor-QD, others).

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

Digestive medicines

• Famotidine (Pepcid AC).
• Omeprazole (Prilosec, Nexium, others).
• Ondansetron.
• Simethicone (Gas-X, Mylicon, others).

Medicines for depression or anxiety

• Sertraline (Zoloft).
• Citalopram (Celexa).
• Escitalopram (Lexapro).

Breastfeeding mothers can usually take many medicines in this category.

Constipation medications

• Docusate (Colace, others).
• Polyethylene glycol (Miralax).

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

If you're breastfeeding and plan to take medicine, check with your healthcare professional. Avoid taking medicine you don't need, such as herbal medicines, high doses of vitamins and other supplements.

If you're taking a medicine during pregnancy, check with your healthcare professional about the medicine and breastfeeding. Most, but not all, medicines that are safe in pregnancy also are safe during breastfeeding.

What if my baby has a reaction?

When you're taking medicine and breastfeeding, watch your baby for any changes. These may include:

• Changes in sleeping habits.
• Changes in eating.
• Fussiness.
• Rash.
• Problems breathing.
• Appearing limp or floppy.

Contact your child's healthcare professional if you notice any changes in how your baby is acting.