Medicines to avoid while breastfeeding

Medicines to avoid while breastfeeding

When you have a baby to look after, retreating under the duvet with a streaming cold or pounding head isn’t always an option, so you may want to reach for the first thing in the medicine cabinet. But which medicines are safe to take while breastfeeding? While traces of medicine can pass into breastmilk, the amounts are so small they are usually considered harmless. However, certain medicines, no matter what the dosage, can have an adverse effect on your baby and should be avoided.

Over-the-counter medication | Alternative remedies | Antibiotics | Contraceptive pill | Antidepressants | Antihistamines | Vitamins | Domperidone | Recreational drugs

What do I need to know about taking medicine if I’m breastfeeding?

If you’re feeling really rough, there’s no need to push on through without medicinal help – you probably had quite enough of that during pregnancy. But it is worth giving the following some thought before diving into the foil blister packs.

  • Dr Google is never to be relied upon, so if you can, ask the advice of your GP or pharmacist. They are best placed to assess the severity of your symptoms and advise on what, if any, medication you should take.
  • Let the GP or pharmacist know if your baby was premature. If she was born early, some of her organs may still be developing and unable to cope with even tiny traces of medications in your breast milk.
  • Always mention if your baby had a low birth weight or a diagnosed medical condition, too, as even those medicines usually considered safe for breastfeeding may not be suitable in those cases.
  • If you can’t get to a doctor or pharmacist, a good rule of thumb is that if a medication is available in a child-friendly formula or if it is commonly prescribed for infants, it’s usually considered safe to take when breastfeeding.

What’s the best way to take medicine when breastfeeding?

If taking medication is unavoidable, and you’ve found a drug that’s safe to use, you can go for it – but there are still ways you can minimise the effects on your baby:

  • Where possible, take any medication right after feeding your baby. This will allow the most time for the medication to be metabolised before the next feed.
  • If there’s a choice, go for drops and sprays over ingested medication.
  • Choose non-drowsy options, which won’t upset your baby’s sleep routine.
  • Avoid ‘combined’ medications. Choose single-ingredient medications rather than ones that contain multiple active ingredients.
  • Check whether the medication is likely to reduce your milk supply so you can be prepared for that.

Is it better to stop breastfeeding while taking medication?

No – the benefits of breastfeeding far outweigh the risks associated with low traces of medication in breastmilk. Also, stopping breastfeeding suddenly, without weaning your baby, will cause unnecessary upset to you both. You could end up with engorged breasts, which can lead to mastitis and blocked ducts. And a different type of milk can sometimes upset your baby’s tummy and digestion a little – neither of which is what you need when you’re already feeling below par.

Which medications are safe while breastfeeding?

Many forms of pain relief and other treatments that weren’t safe to take when pregnant are fine when you’re breastfeeding (you’ll be relieved to hear).

I took ibuprofen, in the lowest dose, while breastfeeding. I tried to take it directly after a feed, to minimise the amount that went into the milk.

Here are a few common drugs you might want to take that are on the approved menu, even when you’re breastfeeding:

  • Pain relief such as paracetamol and ibuprofen (but NOT aspirin – see below)
  • Antacids for indigestion
  • Laxatives
  • Asthma inhalers
  • Thrush medication. It’s quite common for babies to pick up oral thrush on their way down the birth canal, and pass it to you when feeding (thrush loves damp, dark spots like nipples as much as it loves your nether regions) so breastfeeding thrush is quite common. But remember it’s essential you and your baby are both treated at the same time in order to avoid passing the infection back and forth. Speak to your GP who will be able to prescribe something suitable for you both.
  • Anticoagulants (to prevent blood clots). Warfarin and Heparin are protein-bound in the blood and so less likely to enter breastmilk. If you do need to take these drugs, check whether your baby had the vitamin K jab at birth. If any of the anticoagulants do pass to your baby, vitamin K as a coagulant can help to counteract any potential effects.
  • Corticosteroid (anti-inflammatory) injections
  • Vaccinations. This includes the flu jab, MMR and tetanus. In fact, immunity from things like the seasonal flu jab can be passed on to your baby and may help prevent her getting flu during her first winters.

Which medications are not safe when breastfeeding?

There are a few medicines you need to swerve for now:

  • Aspirin. This has been linked to Reye’s syndrome in babies and should be avoided completely when breastfeeding (unless prescribed by your GP as an anti-platelet drug for something like heart disease). While Reye’s is rare, it is dangerous and can be fatal. Symptoms can include vomiting, drowsiness, irritability and seizures.
  • Codeine. Another painkilling drug, codeine is commonly found in over-the-counter combination medications such as Nurofen Plus, Solpadeine Plus and Syndol. It was previously thought safe for breastfeeding mums but the Government’s Medical and Health Products Regulatory Agency (MHRA) revised this in 2013 and has since linked codeine to morphine toxicity in breastfed babies.
  • Decongestants. This includes both nasal and oral versions. Decongestants often contain pseudoephedrine (commonly found in medicines such as Sudofed, Benylin and Lemsip, which can affect your milk supply) or phenylephrine and phenylpropanolamine (also found in decongestants and most cold and flu medicines).
  • Guaifenesin. This is an expectorant which helps to clear phlegm and is often found in cough syrups such as Robitussin and Benylin.

Are there alternative remedies that are safe to take when breastfeeding?

You might have to avoid the usual contents of your medicine cabinet but that doesn’t mean you have to suffer in silence. Most common ailments can be treated or eased with alternative remedies.

If you’re suffering from a cold or the flu

  • Taking echinacea at the first sign of symptoms will provide some relief.
  • Instead of an over-the-counter decongestant, try a saline nasal spray to ease head and sinus congestion.
  • A steam treatment using some peppermint or eucalyptus can also have the same effect.
  • Glycerin and honey can soothe a sore throat instead of taking a cough syrup.

For thrush

  • Thrush can be eased will yoghurt or by taking probiotics.
  • Adding a couple of drops of tea tree oil to your bath can also help, but using any more than that could cause irritation, so don't go pouring a whole bottle in your tub.

For engorgement

  • Cabbage leaves applied to your breasts between feeds is a reliable home remedy.

If you suffer from migraines

  • A small amount of cayenne pepper in your nostrils can help to open the blood vessels and allow better blood flow to your brain – but use too much of this and you’ll have a burning nose to match your migraine. Three to four grains of pepper in each nostril will suffice.

Can I take herbal medicines while breastfeeding?

Herbal medicines and remedies are not necessarily a safer option for breastfeeding women. There has not been extensive research into their safety and efficacy so breastfeeding mothers should exercise the same degree of caution as they would with any medication.

Herbs that are commonly taken by breastfeeding women without any reported side effects include echinacea, which is often used as short term relief for colds, and fenugreek and fennel, which are used to help boost milk supply. Alternative remedies such as chamomile, garlic and ginger and elderflower are all considered harmless.

The herbal remedy St. John’s Wort (sometimes used as a cure for depression) is not recommended for breastfeeding mothers; little is known about its effects on babies.

Can I take antibiotics when breastfeeding?

Most antibiotics are safe to take while breastfeeding and are often prescribed for conditions such as mastitis. Tell your GP that you’re breastfeeding so they can prescribe a suitable antibiotic.

I had antibiotics when I had mastitis. I didn't notice any side effects with my daughter and I felt much better within 24 hours.

One group of antibiotics that should be avoided is quinolones which have been linked to problems in the developing joints of infants.

Although antibiotics are safe to take while breastfeeding, you may still notice small side-effects in your child, including diarrhoea or loose stools, a change in temperament and colic-like symptoms. This will pass once you’ve completed the course of antibiotics.

Taking antibiotics can also upset your own intestinal flora and sometimes lead to a bout of thrush, so you might want to take a probiotic after you finish the course to help redress the balance in your gut.

Can I go back on the pill if I’m still breastfeeding?

Breastfeeding can act as a contraceptive by delaying the return of your period but it isn’t foolproof so talk to your GP about going back on contraceptives – unless you’re hoping for a very close age gap!

pill when breastfeeding

Don’t forget to tell your GP that you’re breastfeeding when you discuss this. You might find that breastfeeding means that you can’t simply go back on your usual pill. Pills that contain oestrogen have been linked to low milk supply so aren’t recommended for women who breastfeed. They will usually prescribe you a progesterone-only contraceptive such as the mini-pill or a progesterone-only implant, injection or coil.

You can start the mini-pill as soon as you feel ready but you may have to wait up to six weeks post-birth to use the other methods of contraception. If you prefer the combined pill or patch, you will need to wait until your baby is at least six months, when their body is better able to metabolise the ingredients.

Is it safe to take the morning-after pill when breastfeeding?

Yes, although the patient information leaflet that accompanies the morning-after pill advises mothers to wait eight hours after taking the pill before breastfeeding, so you may need to give a bottle of expressed milk or formula.

Can I breastfeed on antidepressants?

Not all antidepressants are safe for breastfeeding but there are several that are. When speaking to your GP or health visitor, it’s important to let them know if you want to continue to breastfeed and they’ll be able to prescribe medication that is suitable for you.

I’ve been taking anti-depressants for about three months and have been still been breastfeeding my daughter. I've had great results and my daughter is absolutely fine.

Commonly prescribed antidepressants such as paroxetine, sertraline or amitriptyline are among those considered safe when breastfeeding.

Fluoxetine, also known by its brand name Prozac, is not considered a safe option as it has a long half-life in breastmilk and can lead to a build up of the drug in babies’ bodies.

Many, many women who suffer with postnatal depression (or indeed any sort of depression or mental illness) successfully breastfeed while on medication. It’s definitely not something to feel guilty about at all, in fact quite the opposite. By continuing to breastfeed while seeking treatment for depression and ensuring you are happy and healthy, you’re doing the best for your baby.

Is it safe to take antihistamines if you’re breastfeeding?

If your symptoms are mild then you may be able to get by without relying on antihistamines. However, if you suffer with severe hay fever or other allergies, there may be no option other than medication. Try nasal sprays and eye drops in the first instance as these won’t be ingested and turn up in your breastmilk.

If topical treatments don’t provide the relief you need, try a non-drowsy antihistamine tablet containing either loratadine or cetirizine. Both these drugs are considered safe when breastfeeding. They have various brand names including Clarityn, Benadryl and Piriteze. Always ask the pharmacist to check that the brand you’re buying is suitable.

Can I take vitamins when breastfeeding?

It is recommended that breastfeeding women continue to take 10mcg of vitamin D per day. Vitamin D helps to support your immune system and is beneficial to your baby’s developing joints. If you qualify for Healthy Start vouchers, you will be able to get vitamin D prescriptions free of charge from your GP.

Mothers who adhere to a strict vegan diet will also need to take a B12 supplement as this vitamin is primarily found in animal proteins. A deficiency in vitamin B12 can lead to a anaemia and damage to the nervous system.

While most breastfeeding mothers will get all of their nutrients from a balanced diet, it is perfectly safe to take a multivitamin supplement should you feel you need it. There are several brands specially formulated for breastfeeding.

I’ve been prescribed Domperidone to help my milk supply. Will this affect my baby?

Domperidone (sounding tantalisingly close to Dom Perignon but oh so far away in every other respect) is considered safe as only very low levels get into breastmilk. In fact, larger doses are sometimes used to treat reflux in infants. It is also sometimes known as Motilium.

Recreational or illegal drugs

While there is no extensive research around the effects of recreational drugs on breastfed babies, it is not recommended. Your baby is still developing both physically and cognitively and the potency of recreational drugs, along with the unknown ingredients in many of them, could do irreparable damage to your child. It’s not worth the risk.