Breastfeeding and medications: What’s safe

Wondering if the medications you’re taking are safe for your breastfeeding baby? Take a deep breath—we have good news.

Photo: iStockphoto
Photo: iStockphoto

Whether it’s the occasional antihistamine for a stuffy nose, or a daily prescription needed to treat a disease or disorder, nursing moms worry—a lot—that the medications they take could affect their babies.

“I felt really guilty about having to take antibiotics,” says Amber Fraser, mom to four-year-old annie and one-year-old Abbott. Fraser required medication on several occasions to treat strep throat and upper respiratory infections while she was breastfeeding Annie. She didn’t want to take antibiotics, but didn’t see an alternative.

“Looking after the health of the mother is also looking after the health of the baby,” says Sharon Unger, a neonatologist at Mount Sinai Hospital in Toronto. Women should exercise caution, but never feel guilty for taking care of themselves, she says.

The good news is that Fraser probably fretted for nothing. According to a new report published in the US Journal Pediatrics, very few medications actually enter breastmilk in concentrations high enough to pose a risk to babies. This is particularly important news for women requiring antidepressants or anti-anxiety drugs, who may have been inappropriately counselled into weaning their babies or quitting their meds.

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“In most cases there’s no reason to have to choose between taking your medication and breastfeeding,” says Gideon Koren, a paediatrician and the director of Motherisk (an organization that provides up-to-date advice for pregnant and nursing women and their doctors) at the Hospital for Sick Children in Toronto.

That doesn’t mean we can pop pills blindly, though. It’s important to know the side effects of any medication you’re prescribed, or taking over-the-counter, and be on the lookout for any similar symptoms in your baby. In the case of antibiotics, which can disrupt the healthy balance of gut bacteria, “watch for gastrointestinal problems like diarrhea and report them to your doctor right away,” says Koren. Some antihistamines can cause drowsiness, which should be monitored because a too-sleepy newborn might miss out on feedings.

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Even codeine and oxycodone, which are sometimes prescribed to manage pain after a Caesarean, are compatible with breastfeeding if used properly. Moms are advised to watch their babies for sleepiness, failure to latch, weak sucking and poor weight gain. It’s also preferable, if possible, that new moms only take these drugs for four days. “By day four the baby is suckling a lot more, and more is getting into his or her system,” says Koren.

But there are a few medications that are strictly contraindicated. Drugs used to treat cancer, Phenobarbital (a sedative) and Amidarone (for heart rhythm irregularities), all make their way into breastmilk at unsafe levels. Unger and Koren also both recommend using caution with herbal remedies, as their effects haven’t been properly studied.

The specific health concerns of the mother, as well as the health and age of the baby, need to be considered when making recommendations around the use of medications while nursing, says Koren. Any effects of exposure to drugs in breastmilk pose the biggest risk to premature babies, newborns, and babies who have poorly functioning kidneys. The risk is lowest for healthy babies who are six months or older.

So share your concerns with your doctor, along with a list of everything you’re taking, and then relax. “Usually,” says Koren, “the advantages of breastfeeding far outweigh any possible risks.”

A version of this article appeared in our January 2014 issue with the headline “Milk it,” pp. 47.

 

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