Breastfeeding and Medicine

Drugs found in Breast Milk.

You might be concerned about certain drugs being transferred into your breast milk and their effects on your baby. Some ladies decide not to breastfeed at all, due to strong medication given in the case of epilepsy or hyperthyroidism. 

Many Mothers believe that it is better for their babies to drink formula and avoid the risk of these drugs entering into their breast milk, but there are very few medications that are contraindicated during breastfeeding, and it is advised to first check with the American Academy of Paediatrics, before deciding to wean

In the first week of a baby’s life, while the mother is still producing colostrum, it is important to remember that drug transfer into the breast milk, is much easier during this time and that the baby should be monitored closely. 

There are several factors, which influence whether a particular drug will enter the breast milk more than another, if at all.

Risk Factors Include

  • Plasma concentration: Some drugs have a higher level of build up in the mother’s blood, and these are more likely to be transferred into the breast milk. 
  • Molecule size: Drugs that have bigger molecules are less likely to pass through cell membranes and into the breast milk. 
  • Binding of proteins: Drugs that attach to proteins in the mother’s blood are less likely to pass into the breast milk. 
  • Fat solubility: Drugs that can dissolve in fat are more likely to pass into the breast milk and can be carried along with the fat in breast milk. 
  • Bioavailability: Drugs that are not taken orally by the mother (taken via injection, inhalation or cream), can sometimes have no effect on the baby when consumed orally via the breast milk. 
  • The half-life of the drug:  The time it takes for half the amount of this specific drug to leave the bloodstream. Some drugs are used up quickly and then passed out in the urine and feces. 

Individual Risk Factors of Drug Safety

  • There is low risk for babies who are older than six months old. Babies who are older can get rid of toxins in their systems easier than younger ones, and older babies also do not depend as much on breast milk for their entire nutritional requirements. 
  • There is a medium risk for those babies who are younger than six months and who have specific problems with their metabolisms or their guts. 
  • There is a very high risk for those babies who are premature or sick, especially those with impaired kidney function. 

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How to Minimize Drug Effects

  • If a medication has a short half-life, the mother can avoid feeding her baby until the drug levels have lowered.
  • Mom can pump and dump milk during the times that she is taking risky medication, this is just to keep her milk supply up.
  • Choose medications that are less risky, ask about alternatives. Ask about pediatric approved medications. 
  • Ask about medications that have higher protein binding and those that are of larger molecular size. Also, ask about medicines that do not pass easily into the blood-brain barrier, if possible.
  • Always keep an eye on the baby. Watch especially for drowsiness and gut issues. 
  • Take the medication straight after you have breastfed your baby; this will give the meds a long time to leave your system before you breastfeed again.
  • Avoid taking any unnecessary medication.

Drug package inserts cannot be used to determine whether a drug is safe or not. Drug companies do not do studies that involve pregnant and breastfeeding women, and always add a “not to be taken while pregnant or breastfeeding" on the package, just to protect themselves against lawsuits.

Using CBD oil while breastfeeding

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Medications that should be Avoided if you are Breastfeeding
(not a complete list)

Some medication may decrease milk supply (especially meds containing pseudoephedrine, flu medication, and contraceptives)

Then there are medications, that should never be taken if breastfeeding and these include:

1. Radioactive substances (The mother will need to pump and dump while on these if she wishes to continue to breastfeed afterward)

2. Anticancer drugs (antimetabolites).

3. Immunosuppressive and Antineoplastic drugs.

4. Amphetamines.

Some drugs that are known to Decrease milk production:

  • Alcohol.
  • Estrogens (often found in birth control pills).
  • Ergot Alkaloids (Bromocriptine & Cabergoline).
  • Progestogens.
  • Pseudoephedrine. 

Medications that is possibly harmful to a baby while breastfeeding

  • Lithium.

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Safe Drugs while Breastfeeding

Some drugs that are known to Increase milk production:

  • Motilium (Domperidone) This drug is often prescribed to increase milk production. 
  • Reglan (Metoclopramide).
  • Risperidone.
  • Phenothiazine Neuroleptics.

A list of some safe medication while breastfeeding

  • Acetaminophen / paracetamol (Tylenol and Panadol)
  • Ibuprofen (Advil, Nuprin, Motrin)
  • Dextromethorphan (the active ingredient in Triaminic, Robitussin, Coricidin.)

A list of medication that is still safe, but not as safe as the above "safe" medication

  • Selective serotonin reuptake inhibitors (SSRIs) such as Sertraline (Zoloft) and Paroxetine (Paxil).
  • Bupivacaine (Marcaine).
  • Fentanyl. Aside from being a hundred times more potent than morphine, Fentanyl is highly addictive, and breastfeeding moms should avoid it if they can.

A list of medication that is only moderately safe while breastfeeding

  • Aspirin.
  • Codeine.

Is taking Pepto Bismol safe while breastfeeding?

Natural Alternative Medicine for Colds

  • Vapor rub, eucalyptus oil.
  • Saline nasal sprays.
  • Gargle with salt water.
  • Take a multivitamin and extra vitamin C.
  • Rest. Eat and drink well.
  • Olive Leaf extract will boost the immune system.
  • Use a humidifier.
  • Echinacea is great for boosting your immune system and is safe for breastfeeding mothers.
  • Garlic is a natural antibiotic.
  • Cayenne pepper and nutmeg can help for prevention and treatment of colds. Use on all foods.
  • Fenugreek tea can help for head and chest congestion and even for a cough. Fenugreek also increases milk supply.
  • Slippery elm bark comes in throat lozenges.

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Signs that your Baby does not Agree with a Particular Medication

  • Baby is more unsettled and fussy than usual.
  • Baby has diarrhea.
  • Baby is not sleeping enough.
  • Your milk supply is starting to dry up.

Always ask your doctor before taking any medications while breastfeeding.

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