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Is it Safe to Use Medicine During Breastfeeding?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 7, 2024.

Introduction | Top Tips for Mom's Who are Breastfeeding | Table of Drugs Reported as Safe

Although most drugs are safe to use when you're breastfeeding, many will get into your milk to some degree and may even affect your milk supply.

It is widely accepted that human milk is best for an infant. The benefits are substantial for the baby, providing the ideal nutrition, antibodies to protect against illness, and a healthy weight. There are benefits for mom, too: it increases bonding and relaxation, can be a cost-saver, and provides health benefits like a lowered risk for high blood pressure, type 2 diabetes, and breast, ovarian and endometrial cancer.

For drugs that cannot be used, there is usually a safe alternative that can be recommended. Classes of drugs generally considered not compatible with breastfeeding include statins for high cholesterol treatment, amphetamines, ergotamines for migraines and chemotherapy agents for cancer treatment.4

Please Note: This is not a complete list of safe or unsafe drugs to use during breastfeeding. Always consult your doctor or healthcare specialist for medical advice in relation to drug use while pregnant or breastfeeding. Prescription and over-the-counter drug use should be made on a case-by-case basis, and this information may not be applicable to every situation.

Introduction

The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend exclusive breastfeeding for the first 6 months, with continued breastfeeding along with introduction of appropriate foods for up to 2 years of age or longer, as mutually desired. Exclusive breastfeeding is also recommended for at least 6 months by most experts, and extended to 12 months while introducing complementary foods, per U.S. Dietary Guidelines.

Over this time period many mothers will need to take medications of some type during breastfeeding, whether it be short-term (for a headache, for example), or for more chronic conditions (like asthma or depression). This may raise questions about the safety of common treatments while nursing. Even though you're a new mom with new responsibilities, your health still matters, too.

Check with your pediatrician before taking any kind of prescription or over-the-counter (OTC) medication, vitamin, and herbal or dietary supplement. Just because a label says "natural" does not always mean it's safe.

Top 8 Tips for Breastfeeding and Medication Use

Most, but not all, medications that a breastfeeding woman might take are compatible with breastfeeding according to the American Academy of Pediatrics. However, only take a medication when absolutely needed, at the lowest dose and for the shortest time possible. Check with your healthcare provider before medication use. In some rare instances, you may need to express and store your milk until a harmful drug is eliminated from your body.

  1. Ask your doctor about the risks and benefits of any medication prescribed while you are breastfeeding, or any medication, herb or vitamin you choose from OTC options that do not require a prescription.
  2. Special precautions may be needed in preterm (premature) infants and neonates, due to their size and organ systems that are even less developed than a regular term infant.
  3. When possible, take medications that are given only once a day right after a feeding when your baby will have the longest period without nursing; for many women this is the last feeding of the night before the infant's bedtime.
  4. Watch your baby for side effects such as sleepiness, irritability, loss of appetite, diarrhea, sleepiness, excessive crying, vomiting, or skin rashes or any other known reactions of the medication. Call your baby's pediatrician right away if any of these symptoms appear.
  5. Only water-miscible (soluble) cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.1
  6. After using eye drops, place pressure over the tear duct by inside corner of eye for at least one minute to lower amount of drug that may reach breastmilk. Remove excess solution with a tissue.
  7. Avoid long-acting (LA), extended-release (ER), and combination forms of medications, when possible. Shorter-acting medications are eliminated from your body more quickly, and single medications (versus combined drugs in one tablet) give you greater flexibility in dosing. 
  8. When more than one medication or a combination medication is used, follow the breastfeeding recommendations for the most problematic medication. Speak with your pediatrician for any questions.

For more detailed information about how a drug you're taking might affect your breast milk or your baby, check the Drugs.com breastfeeding warnings pages. Always follow the directions of your healthcare provider.

Table 1: Selected Drugs Reported as Safe During Breastfeeding in Normal Doses

Drug or Class Brand or Generic Name Notes
acetaminophen Tylenol

OTC; used for pain/fever/headache; amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.1

This drug is considered compatible with breastfeeding by the American Academy of Pediatrics and WHO.2,3

acyclovir and valacyclovir Zovirax, Valtrex Rx; antiviral for herpes infections; the dosage of acyclovir in milk is only about 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. Valacyclovir is a prodrug of acyclovir.1,2
antacids (aluminum, calcium, magnesium) Maalox, Mylanta, Tums, Rolaids

OTC; used for stomach upset, heartburn (dyspepsia)

The World Health Organization (WHO) and LactRx consider compatible with breastfeeding; however, continue to monitor baby for side effects.1,2,3

aspirin (low-dose, [75 to 325 mg daily ONLY if recommended by doctor]

Prescription/over-the-counter; Bayer Aspirin, Bufferin, Ecotrin, others.

In general, aspirin use is best avoided during breastfeeding. Acetaminophen may be safer for pain relief.

Expert opinion indicates that low-dose (75 to 325 mg daily) aspirin may be used as a blood thinning agent for use in breastfeeding women who require it. Monitor the infant for bruising and bleeding.1

Avoid high-dose, long-term use of aspirin, if possible. A case of metabolic acidosis has been reported.2,3

bupivacaine Marcaine Rx; a local anesthetic used in labor/delivery. Because of the low levels of bupivacaine in breastmilk, and it is not orally absorbed, amounts received by the infant are small and it has not caused any adverse effects in breastfed infants.1,3
caffeine

Found in coffee (80-150 mg per 6 ounce cup), tea, soft drinks (cola), energy drinks, yerba mate, chocolate, guarana, some OTC medications.

For example, one Starbucks Grande (16 oz) contains ~300 mg caffeine.

A stimulant that DOES pass into breast milk.

Excess caffeine in the mother can lead to stimulation in infants. Watch for irritability in your newborn.

Avoid concentrated energy drinks, pure caffeine tablets.

A maximum caffeine consumption of 300 mg to 500 mg per day is suggested in the U.S., in Europe 200 mg is the recommended likely safe limit.1

Caffeine levels from breast milk may be higher in preterm infants; lower caffeine consumption may be advisable.

Coffee intake >450 mL per day (about 2 measured cups) may lead to a decrease iron in breastmilk and cause mild iron deficiency in some infants.1

cephalosporins (i.e. Keflex or cephalexin)

Most cephalosporins are considered compatible with breastfeeding. Check each drug individually.

Rx; broad-spectrum antibiotics for infections.

Limited data suggests that many cephalosporins given to the mother produce low levels in milk that are usually not expected to cause side effects in breastfed infants.5

Maternal infection treatments have resulted in reports of neonatal diarrhea and thrush. May interfere with gut flora in infant. Rare serious allergies have been reported in one infant.1,2

clotrimazole

Clotrimazole (troches or topical)

Rx/OTC; used to treat yeast and fungal infections.

Poor oral bioavailability, unlikely to adversely affect the breastfed infant, including topical application to the nipples.1

contraceptives (progestin-only or "mini-pills"): norethindrone, etonogestrel levonorgestrel, drospirenone)

Various brand and generic options available.

Used for birth control. Generic options may be available.

Nonhormonal methods of birth control may be preferred during breastfeeding in some women (this includes the copper IUD, condoms, diaphragm and cervical cap).

You can use the shot, implant, some types of IUDs, and progestin-only birth control pills (“mini-pills”) right after giving birth.6

Progestin-only contraceptives are considered the hormonal contraceptives of choice during lactation, especially during the first 4 weeks postpartum.6 Norethindrone has not been shown to affect milk supply, milk composition or growth and development of the infant based on fair quality evidence.1

Research has found that combined birth control pills (that contain estrogen + progestin) do not affect milk production if started 4 weeks after delivery.6

Combination birth control pills started within 3 to 6 weeks after delivery may elevate risk for blood clots, based on patient risk level.1,3,6

corticosteroids

Examples: prednisone, prednisolone

Rx; used to treat inflammation, pain of joints and many other conditions.

As reported by the WHO, corticosteroids at normal doses during breastfeeding can be used, with monitoring of the baby.3

LactRx reports that amounts of corticosteroids are very low in breastmilk and no adverse effects have been reported in breastfed infants with any corticosteroid.1

High doses might cause temporary loss of milk supply.1

decongestant nasal sprays Examples: Afrin (oxymetazoline), Sinex (phenylephrine)

OTC; Used to treat stuffy noses.

Limited systemic absorption.

Recommended over oral decongestants (such as pseudoephedrine or phenylephrine), which may inhibit milk production.1

digoxin Lanoxin

Rx; used for heart failure, other heart problems.

If given intravenously, avoid breastfeeding for 2 hours after dose.1

Because of the low levels of digoxin in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.1

erythromycin Erythrocin; Ery-Tab

Rx; macrolide used for skin and respiratory infections.

Low levels in breast milk; used safely in infants.

Monitor infant for diarrhea, candidiasis (thrush, diaper rash), irritability.1

fexofenadine Allegra Allergy

OTC; non-drowsy antihistamine for allergies and hay fever.

Lack of sedation and low milk levels; maternal use of fexofenadine would not be expected to cause any adverse effects in breastfed infants.1

Combined use with decongestants (i.e., phenylephrine, pseudoephedrine) may lower breast milk production.

fluconazole Diflucan

Rx; May be used to treat yeast infections, Candida mastitis.

Acceptable in nursing mothers because amounts in breastmilk are less than the neonatal dose.1,2

heparin and low molecular weight heparins (examples: dalteparin, enoxaparin) Note: preservative-free heparin sodium injection is recommended when heparin therapy is needed during lactation.

Rx; used to keep blood from clotting.

Not expected to be appreciably excreted into breastmilk or absorbed by the infant due to high molecular weights. No special precautions are required.1

ibuprofen Motrin, Advil, generics and store brands

Rx/OTC: used for muscle and joint pain relief, to lower inflammation, fever, headache relief.

Due to low levels in breastmilk, short action (half-life), and safe use in infants in doses higher than those found in breastmilk, ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers.1,3

inhaled bronchodilators albuterol, levalbuterol, terbutaline

Rx; used for asthma.

Limited published data; data from terbutaline indicate that very little is expected to be excreted into breastmilk.

Experts agree use of inhaled bronchodilators acceptable due to low bioavailability and maternal serum levels after use.1

insulin

Mothers with diabetes using insulin may nurse their infants.

Careful observation of increased maternal caloric needs, insulin needs and maternal blood glucose levels are needed.

Rx; for diabetes / elevated blood sugar.

Basal insulin requirements may drop up to 21% on average during lactation, but is widely variable.1

Endogenous insulin is a normal component of breast milk.

Insulin, including newer biosynthetic insulins (aspart, detemir, glargine, glulisine, lispro) is a protein that is inactivated and destroyed in the digestive tract of the infant if taken by mouth.2,7

laxatives psyllium (Metamucil), docusate (Colace), polyethylene glycol (Miralax).

OTC; used to treat constipation.

Few data are available, but psyllium is not absorbed from the gastrointestinal tract, so it cannot enter the breastmilk. It is acceptable to use during breastfeeding.1,2

Docusate is minimally absorbed and is unlikely to be found in breastmilk. Laxatives that are completely unabsorbed may be preferred over docusate.1,2

Polyethylene glycol is very poorly absorbed from the gastrointestinal tract, so it cannot enter the breastmilk in important amounts. No special precautions are required.1,2

lidocaine Xylocaine

Rx; a local anesthetic.

Lidocaine is poorly absorbed by newborns. Lidocaine is not expected to cause side effects in breastfed infants.1,2

loratadine Claritin, Claritin 24-Hour, Claritin RediTabs

OTC; non-drowsy antihistamine for allergies and hay fever.

Lack of sedation and low milk levels. Not expected to cause adverse effects in nursing infants. Some experts recommend to use at the lowest dose as a preferred choice during lacation.2

Loratadine might have a negative effect on lactation, especially in combination with a decongestant like pseudoephedrine or phenylephrine.1,2

low molecular weight heparins (examples: enoxaparin, dalteparin) Lovenox, Fragmin Rx; used as an anticoagulant; not expected to be excreted into breastmilk due to high molecular weight (2000 to 8000 daltons).1,2
magnesium sulfate  

Rx; used for prevention and control of seizures in pre-eclampsia and eclampsia.

Postpartum IV use longer than 6 hours may delay onset of lactation.1

See Summary of Use during Lactation2

methyldopa  

Rx; used to treat high blood pressure; no special precautions needed.

Because of the low levels of methyldopa in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.1,2

metoprolol Lopressor

Rx; a beta-blocker used to treat high blood pressure.

Small amounts ingested by infant; no special precautions are required.

Studies on the use of metoprolol during breastfeeding have found no adverse reactions (side effects) in breastfed infants.

However, monitor for slow heart rate and inactivity (listlessness) due to low blood sugar levels.1,2

miconazole (topical use) Monistat

OTC; used to treat yeast infections.

Poor oral bioavailability and poor absorption from skin or vagina. Unlikely to affect the breastfed infant, including topical application to the nipples, but rarely prescribed.1,2

nifedipine Procardia

Rx; calcium channel blocker used to treat high blood pressure and angina (chest pain); also used to treat painful nipple vasospasm.1

Studies on the use of nifedipine during breastfeeding have found no adverse reactions in breastfed infants. Amount ingested by infant are small.1,2

penicillins amoxicillin, penicillin G, penicillin V

Rx; used to treat bacterial infections.

Occasionally, rash and disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, have been reported with penicillins, but these effects have not been adequately evaluated. Low levels occur in milk.

Amoxicillin, penicillin G, penicillin V are acceptable in nursing mothers.1,2

propranolol Inderal LA, Inderal XL, InnoPran XL

Rx; a beta blocker used to treat heart problems, high blood pressure, and infantile hemangiomas.

Low levels in breastmilk; studies in infants have not found side effects due to propranolol. Not expected to cause side effects in breastfed infants. No special precautions are needed.1,2

theophylline

Elixophyllin, Theo-24, others

Rx; used to treat asthma and bronchitis.

Monitor infant for irritability, stimulation, and trouble sleeping in newborn and especially preterm infants.

Keep maternal serum concentrations in the lower part of the therapeutic range and monitor the infant for signs of theophylline side effects. Consider infant serum monitoring if needed.

Delay nursing for 2 hours (after IV dose) or 4 hours (after oral immediate-release dose) if possible (to delay dose received by breastfed infnat). Delayed nursing may have no effect if taking long-acting (sustained-release) forms.1,2

tretinoin topical Avita, Atralin, Renova, Retin A

Rx; topical cream used for acne; use only water-miscible cream or gel products.

Do not apply directly to nipple and areola. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated.1,2
thyroid replacement Synthroid, levothyroxine

Rx; replaces the thyroid hormone normally produced by your body to help regulate your energy and metabolism.

Levothyroxine is excreted into milk, but as T4 it is a normal component of breast milk. Use is considered acceptable. The American Thyroid Association recommends hypothyroidism in lactating women should be treated with levothyroxine.1,2

vaccines

Breastfed infants should be vaccinated according to routine established schedules from the ACIP and as recommended by your healthcare provider.

According to the ACIP’s General Best Practice Guidelines for Immunization in Special Situations, except for smallpox and yellow fever vaccines, neither inactivated nor live-virus vaccines administered to a lactating woman affect the safety of breastfeeding for women or their infants.

When nursing mothers cannot avoid or postpone travel to areas endemic for yellow fever in which risk for acquisition is high, these women should be vaccinated.8

COVID-19 vaccines: If you are breastfeeding, you can receive a COVID vaccine. According to the CDC, vaccines are safe and effective at preventing COVID-19 in mothers who are breastfeeding and are safe for their babies.

Research on the safety of COVID-19 vaccination while breastfeeding indicates no severe reactions after the first or second dose in the breastfeeding mother or the breastfed child. There has been no evidence to suggest that COVID-19 vaccines are harmful to those who have received a vaccine and are breastfeeding or to their babies.

Studies have shown that breastfeeding mothers who have received mRNA COVID-19 vaccines have antibodies in their breast milk, which could help protect their babies.9

vancomycin (oral) Vancocin, Firvanq

Rx; oral antibiotic often used to fight bacterial infections in the bowels. 

Limited information indicates that oral vancomycin produces low levels in milk. 

Because vancomycin is poorly absorbed when taken orally, it is unlikely to enter the bloodstream of the infant or cause side effects. No special precautions are required. 1,2

verapamil Calan SR, Verelan, Verelan PM

Rx; calcium channel blocker used for high blood pressure, angina (chest pain).

Data are limited but suggest that doses of verapamil up to 360 mg daily given to the mother produce low levels in milk and newborns.

Verapamil would not be expected to cause side effects in breastfed infants, especially in infants over 2 months.1,2

warfarin Coumadin, Jantoven

Rx; an anticoagulant (blood thinner) used to treat or prevent blood clots. Helps to prevent heart attacks, stroke and other serious conditions.

Very low levels of warfarin occur in milk with warfarin doses in the mother up to at least 12 mg per day.

Amounts consumed by the infant are small. No side effects in breastfed infants have been reported from maternal warfarin use during breastfeeding, even with a maternal dose of 25 mg daily for 7 days.

No special precautions are suggested.1,2

Rx - prescription only; OTC - over-the-counter; his list does not include all possible drugs in a class.

Additional monitoring or laboratory testing may be required for your infant. Prescribing is made on a case-by-case basis by your healthcare provider. Always seek the advice of your healthcare provider when taking any medication during breastfeeding.

See Also

Sources

  1. LactRx App. Mother to Baby. Accessed online 1.10.2024 at https://mothertobaby.org/lactrx/
  2. Drugs.com. Medicine use while Breastfeeding. 2024. Accessed Jan 10, 2024 at https://www.drugs.com/breastfeeding/
  3. Department of Adolescent and Child Health and Development. UNICEF. World Health Organization. Breastfeeding and maternal medication. Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs Accessed Jan. 10, 2024 at https://iris.who.int/bitstream/handle/10665/62435/55732.pdf
  4. Kellams A (author). Breastfeeding: Parental education and support. Updated Aug 2023. Up to Date. Accessed Feb 19, 2024 at https://www.uptodate.com/contents/breastfeeding-parental-education-and-support
  5. Hale's Medication and Mother's Milk. Online. 2021. Springer Publishing Company. Accessed July 15, 2021 at https://www.halesmeds.com/categories
  6. What's the best birth control option while breastfeeding? Planned Parenthood. Accessed July 16, 2021 at https://www.plannedparenthood.org/learn/birth-control/breastfeeding/whats-best-birth-control-option-while-breastfeeding
  7. Insulin regular. Pregnancy and Breastfeeding Warnings. Drugs.com. Accessed Jan 15, 2023 at https://www.drugs.com/pregnancy/insulin-regular.html#breastfeeding-warnings
  8. Vaccination Recommendations and Guidelines of the ACIP. Breastfeeding and Vaccination. US Centers for Disease Control and Prevention (CDC). Updated June 20, 2023. Accessed Jan 16, 2024 at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html#breastfeeding
  9. COVID-19 and Breastfeeding. US Centers for Disease Control and Prevention (CDC). Last reviewed March 25, 2021. Accessed Jan 16, 2024 at https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html#

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.