Medication and Substance Use During Breastfeeding

Medications that are considered safe include most nonprescription (over-the-counter) medications. Exceptions are antihistamines (commonly contained in cough and cold remedies, allergy medications, motion sickness medications, and sleep aids) and, if taken in large amounts for a long time, aspirin and other salicylates. Acetaminophen and ibuprofen, taken in usual doses, appear to be safe.

Medications that are applied to the skin, eyes, or nose or that are inhaled are usually safe.

Most antihypertensive medications Medications High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more do not cause significant problems in breastfed babies. Women may take beta-blockers during breastfeeding, but the baby should be checked regularly for possible side effects, such as a slow heart rate and low blood pressure.

Caffeine and theophylline do not harm breastfed babies but may make them irritable. The baby's heart and breathing rates may increase.

Even though some medications are reportedly safe for breastfed babies, women who are breastfeeding should consult a health care professional before taking any medication, even an over-the-counter medication, or a medicinal herb. All medication labels should be checked to see whether they contain warnings against use during breastfeeding.

Some medications require a doctor’s supervision during their use. Taking them safely while breastfeeding may require the following:

Most antianxiety medications Misuse of Antianxiety Medications and Sedatives Antianxiety and sedative medications are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more , antidepressants Medications for depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , and antipsychotic medications Antipsychotic drugs Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more require a doctor’s supervision, even though they are unlikely to cause significant problems in the baby. However, these medications stay in the body a long time. During the first few months of life, babies may have difficulty eliminating the medications, and the medications may affect the baby’s nervous system. For example, the antianxiety medication diazepam (a benzodiazepine) causes lethargy, drowsiness, and weight loss in breastfed babies. Babies eliminate phenobarbital (an antiseizure medication and a barbiturate) slowly, so this medication may cause excessive drowsiness. Because of these effects, doctors reduce the dose of benzodiazepines and barbiturates as well as monitor their use by women who are breastfeeding.

Warfarin (a medication that prevents blood from clotting) can be taken if the baby is full-term and healthy. Warfarin does not appear to enter breast milk. People who take warfarin, including women who are breastfeeding, need to have blood tests done periodically to determine whether blood is clotting normally. Warfarin can cause a tendency to bruise or bleed.

Some medications and other substances should not be taken by mothers who are breastfeeding Breastfeeding Breast milk is the ideal food for newborns and infants. Although babies may be fed breast milk or formula, the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend... read more . They include

Medications that may suppress milk production include estrogen Hormone Therapy for Menopause Menopause is the permanent end of menstrual periods, ovulation, and fertility. For up to several years before and just after menopause, estrogen levels fluctuate widely, periods become irregular... read more , oral contraceptives Oral Contraceptives Contraceptive hormones can be Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings) Applied to the skin (patch) Implanted under the skin read more that contain high-dose estrogen and a progestin, trazodone (an antidepressant), and certain medications used to treat Parkinson disease (bromocriptine and levodopa Levodopa/carbidopa Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more ).

If women who are breastfeeding must take a drug that may harm the baby, they must stop breastfeeding. But they can resume breastfeeding after they stop taking the drug. While taking the drug, women can maintain their milk supply by pumping breast milk, which is then discarded.

Women who are breastfeeding should consult their health care professional about all the drugs they are taking or about to start.

Women who smoke should not breastfeed within 2 hours of smoking and should never smoke in the presence of their baby whether they are breastfeeding or not. Smoking reduces milk production and interferes with normal weight gain in the baby.

Alcohol consumed in large amounts can make the baby drowsy and cause profuse sweating. The baby's length may not increase normally, and the baby may gain excess weight. Drinking up to 1 standard drink per day does not appear to harm the breastfeeding infant, especially if a woman waits at least 2 hours after a single drink before breastfeeding.