Breastfeeding and Medications

There are several ailments and diseases that may affect a breastfeeding mother. It is known that most drugs and chemicals taken by the mother pass onto the breast milk from maternal blood to varying extents. While some of these agents are harmless for the breastfeeding baby some may cause serious harm.

Many illnesses, including depression (commonly post partum depression), can be treated in the mother without discontinuing breastfeeding or harming the baby.

Why may taking medications whilst breastfeeding be dangerous?

As the medication passes from the mother’s blood into her breast milk the baby takes it in while feeding. Because of the small size and immature enzyme systems of the baby they are unable to metabolize the drugs adequately.

What medications may be taken whilst breastfeeding?

Broadly the medications that may be taken by the mothers while breastfeeding include:-

• Pain relievers and fever relievers like paracetamol and ibuprofen. Similar agent aspirin however is not be taken by breastfeeding mothers.
• Many antibiotics.
• Many cough medications. Those containing agents like codeine, phenylephrine and guaifenesin however are not to be taken.
• Anti allergic medications and medications to treat hay fever. These are called antihistaminics and are usually safe in a breastfeeding mother.
• Inhalers containing asthma medications.
• Vitamin supplements in normally recommended doses.
• Some local anesthetic agents.
• Vaccines like MMR (Measles mumps and rubella vaccine), tetanus and flu shots.
• Cosmetic products like dyes, hair straighteners, perming agents, fake tans etc.

Contraceptives whilst breastfeeding

Some of the contraceptives that are non-hormonal are safe during breastfeeding. These include:

• male and female condoms
• diaphragms
• IUDs (intra uterine devices)

Among hormonal contraceptives progestin only forms of hormonal contraception including pills, depot medroxyprogesterone acetate (Depoprovera) and the etonogestrel implant (Implanon®) are safe for breastfeeding women. These agents have been seen to produce no changes in breast milk composition, breast milk supply, duration of breastfeeding or infant growth.

Those who take combined estrogen/progestin oral contraceptives may suffer from decreased milk production in breastfeeding women. Women who wish to take combined pills may take ones with lowest dose of estrogen in the combination.

Antidepressants whilst breastfeeding

Antidepressants may be needed in women who suffer from major depression prior to, during or just after pregnancy (post partum pregnancy). In these women psychotherapy should be the first choice of treatment.

Antidepressants should be used if psychotherapy is not useful or not available. All antidepressants are secreted in breast milk.

Of all antidepressants Sertraline, a selective serotonin reuptake inhibitors (SSRI) has been recommended in breastfeeding mothers as it has little side effects in the infant and low blood levels.

Another SSRI (Fluoxetine) has several metabolites that may be transmitted to the baby via breast milk. This may lead to lethargy, poor feeding, fever and loss of muscle tone.