Medications taken by Mom while breastfeeding

General Considerations

Don't stop taking a mental health medication if you become pregnant or breastfeed.
- Get help to figure it out.
Don't pump and dump breastmilk if you start a medication.
- Ask a breastfeeding expert, because most medications are OK.
Many medications have not been studied in regards to breastfeeding.
Resources are available to help with making decisions, as you weigh the benefits of breastfeeding against the risks of the drug harming your baby or decreasing your milk supply.

Do you r eally need the drug?
How much of your baby's milk intake is YOUR breastmilk?
Is the medication you're taking sometimes given directly to newborns?
Is your baby premature, very young, or have health problems? This affects how your baby handles the medication.
How much of the drug gets from your digestive system and blood stream and then passes into your breastmilk?
Will the drug decrease your milk supply?
What are the possible side effects for your breastfed baby?
Are you taking more than one drug, such that the side effects might add up?

Of course, you can call the office to ask about a medication you're considering.
Check these sites for yourself, as this is where we will look also!

Drugs and Lactation Database (LactMed), National Library of Medicine/National Institutes of Health
- https://www.ncbi.nlm.nih.gov/books/NBK501922/?report=classic
Dr Thomas Hale’s Medications and Mother’s Milk; Infant Risk Center at Texas Tech University
- https://www.infantrisk.com/
MotherToBaby medication fact sheets
- https://mothertobaby.org/fact-sheets-parent/
Sachs HC; American Academy of Pediatrics, Committee on Drugs. Clinical report: The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796-e809. Reaffirmed May 2018
- https://pediatrics.aappublications.org/content/132/3/e796

"Pump and Dump" is rarely necessary. Ask!

If your baby is term and healthy, resume nursing when you're alert, as the anesthesia has cleared from your milk.
If your baby is a newborn and preterm, has breathing issues, low blood pressure or poor muscle tone, pump and dump for 12-24 hours.

A short acting drug, instead of long acting, is likely OK.
Consider pumping and dumping for 4-8 hours if your baby is less than 2 months old or has health problems.

Postpartum pain from a C-section or perineal trauma is most severe in the first few days after delivery, BEFORE your milk comes in. Without milk flow, drugs have no way to pass to your baby.
While hospitalized
- Butorphanol (Stadol) or Fentanyl , is OK, as very little of these get to your breastmilk.
- Another option is Morphine, a narcotic taken by mouth, by shot or intravenously
By 3-4 days after delivery, your acute pain will improve. Thus, about the time your milk comes in, you won't need the narcotic any longer.
- Take I buprofen (Motrin, Advil) or acetaminophen (Tylenol) regularly to control baseline pain.

Until the last few years, mothers were frequently discharged from the hospital with a supply of narcotics for postpartum pain. By around 2020, a public health campaign was launched to address the opiod epidemic in USA. Now it's rare for new mothers to take narcotics after leaving the hospital.
If narcotic pain control is necessary for bit, these are things to know:
- CODEINE, usually mixed with acetaminophen, as "Tylenol #3," should never be prescirbed for children or breastfeeding mothers. Some people metabolize this drug rapidly, which results in dangerously high levels of the drug, which can cause severe sleepiness, slowed heart rate, and breathing can stop.
- These 2 narcotics are used instead of codeine, but caution is still needed.
  - Oxycodone is often combined with acetaminophen (Tylenol) as Percocet, Tylox, Endocet and Roxicet.
  - Hydrocodone is often combined with acetaminophen (Tylenol) as Lorcet, Lortab, Norco and Vicodin.

Click here to learn more about Baby Blues, Perinatal Mood and Anxiety Disorders and Postpartum Depression.
Untreated anxiety and depression is a risk for both mothers and babies.
Many mental health drugs are compatible with breastfeeding.
If a certain drug worked in the past, it will likely work again.
These drugs are most commonly used:
- sertraline (Zoloft); escitalopram (Lexapro); citalopram (Celexa); paroxetine (Paxil); fluoxetine (Prozac)
If anxiety is preventing you from falling asleep despite being exhausted, try to avoid taking sleeping pills, because you risk falling asleep while nursing. Also, sleeping pills won't help the underlying anxiety or depression.

For panic attacks, Lorazepam (Ativan) and alprazolam (Xanax) are preferred, because they are short acting.
Short term intermittent use is fine while breastfeeding if your baby is term and over 1 week old.
If these drugs are needed regularly, consider starting a maintenance antianxiety drug instead, or if already on one, you may need to adjust the dose or try a different option.

Chemotherapy agents
Pseudoephedrine decongestant
Sulfa antibiotics while a baby is less than 6 weeks old.
Ergotamines (Cafergot) - sometimes used to treat headaches.
Anti-cholesterol drugs may affect fat metabolism in the baby.
Antabus (disulfiram) is a drug to stop alcohol cravings in recovering alcoholics. A baby could have a severe reaction to this.
Seizure drugs Felbamate and Valproic Acid
Click here to read about Herbal supplements to increase milk supply

Small pox and yellow fever vaccines are the only vaccines that should NOT be given to breastfeeding mothers, due to risks to the baby.
Breastfeeding does not interfere with the infant’s immune response to most routine immunizations.

Kay Anderson MD, IBCLC
5/23