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Safe Medications during Breastfeeding

Please Note: Always consult your doctor or healthcare specialist for medical advice in relation to drug use while pregnant or breastfeeding.

Many mothers need to take medications during breastfeeding. Although many drugs are safe to use when you're breastfeeding, most will get into your milk to some degree and may even affect your milk supply. To be safe, check with your child's doctor before taking any kind of medication, even over-the-counter drugs. If you have more questions about how a drug you're taking might affect your breast milk or your baby, check our pregnancy warnings and breastfeeding warnings pages.

Special precautions may be needed in preterm (premature) infants.

If 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 the last feeding of the night before the infants bedtime.

Drugs Reported as Safe to Take in Usual Doses

Name of Drug/Class Brand or Generic Name Use
Acetaminophen Tylenol OTC; Used for pain/fever/headache
Acyclovir and valacyclovir Zovirax, Valtrex Rx; Antiviral for herpes infections
Antacids (aluminum, magnesium) Maalox, Mylanta OTC; Stomach upset (dyspepsia)
Aspirin Aspirin is best avoided during breastfeeding; however, some expert opinion indicates that low-dose (75 to 162 mg daily) aspirin may be considered as an a blood thinning drug for use in breastfeeding women; avoid high-dose aspirin. OTC; Used for pain relief
Bupivacaine Marcaine Rx; A local anesthetic used in labor/delivery
Caffeine Found in coffee, soft drinks, energy drinks; 300 mg per day max suggested. (2-3 cups). Avoid concentrated energy drinks, caffeine tablets. A stimulant
Cephalosporins (i.e. Keflex or cephalexin)
Most cephalosporins are considered compatible with breastfeeding; may interfere with gut flora in infant leading to diarrhea or thrush. Rx; Broad-spectrum antibiotics for infections
Clotrimazole Lotrimin, clotrimazole troches or topical; poor oral bioavailability, unlikely to adversely affect the breastfed infant. Rx/OTC; Used to treat yeast and fungal infections
Contraceptives (progestin-only norethindrone) Micronor, Errin, Heather, other norethindrone brands; estrogen may lower milk production and protein content. Rx; Used for birth control; generic, lower cost versions of norethindrone are available.
Corticosteroids
Prednisone, Prednisolone
Rx; Used to treat inflammation of joints and other conditions
Decongestant nasal sprays Afrin (oxymetazoline) OTC; Used to treat stuffy noses; limited systemic absorption; recommended over oral decongestants
Digoxin Lanoxin Rx; Used for heart failure, other  heart problems; if given intravenously, avoid breastfeeding for 2 hours after dose
Erythromycin Erythrocin; Ery-Tab
Rx; Used for skin and respiratory infections
Fexofenadine Allegra Allergy
OTC; Antihistamine for allergies and hay fever
Fluconazole Diflucan Rx; Used to treat yeast infections
Heparin and LMW heparins Note: Preservative-free Heparin Sodium Injection is recommended when heparin therapy is needed during lactation Rx; Used to keep blood from clotting
Ibuprofen Motrin, Advil Rx/OTC: Used for pain relief
Inhaled bronchodilators Albuterol, terbutaline
Rx; Used for asthma; no published data; experts agree use of inhaled bronchodilators acceptable due to low bioavailability and maternal serum levels after use
Insulin Careful observation of increased maternal caloric needs and maternal blood glucose levels are needed. Rx; For diabetes; dosage required may drop up to 25 percent during lactation
Laxatives, bulk-forming and stool softening Metamucil, Colace OTC; Used to treat constipation
Lidocaine Xylocaine Rx; A local anesthetic
Loratadine Claritin, Claritin RediTabs OTC; Antihistamine for allergies and hay fever
Low molecular weight heparins (enoxaparin, dalteparin, tinzaparin) Lovenox, Fragmin,Innohep Rx; Anticoagulants; not expected to be excreted into breastmilk
Magnesium sulfate
Rx; Used to treat preeclampsia and eclampsia
Methyldopa Aldomet Rx; Used to treat high blood pressure
Methylergonovine (short courses; use caution) Methergine Rx; Used to prevent or control bleeding after childbirth
Metoprolol Lopressor Rx; A beta-blocker used to treat high blood pressure
Miconazole (topical use) Monistat
OTC; Used to treat yeast infections
Nifedipine Adalat, Procardia - limited data suggests no or minimal risk to infant; use caution Rx; Used for high blood pressure and Raynaud's syndrome of the nipple
Penicillins Amoxicillin, ticarcillin
Rx; Used to treat bacterial infections
Propranolol AAP considers compatible with breastfeeding, but monitor infant for respiratory depression, low heart rate and low blood sugar Rx; A beta blocker used to treat heart problems, and high blood pressure
Theophylline Theo-24; monitor for irritability Rx; Used to treat asthma and bronchitis
Tretinoin topical Retin A Rx; Cream used for acne; use only water-miscible cream or gel products
Thyroid replacement Synthroid Rx; Used to treat thyroid problems

Vaccines (except smallpox and yellow fever)

Vancomycin Vancocin Rx; An antibiotic
Verapamil Calan, Isoptin,Verelan Rx; Used for high blood pressure
Warfarin Coumadin Rx; Used to treat or prevent blood clots

Drugs Probably Safe in Usual Doses

Little is known about the effects of these drugs on a breastfeeding infant, but if there is an effect, it will probably be mild. In rare cases, a child has an allergic reaction. Always check with your doctor.

Name of Drug or Class Brand or Generic Name Use
ACE inhibitors Captopril, Enalapril (Vasotec), Benazepril (Lotensin) Rx; Used to treat high blood pressure
Anticholinergic agents Pro-Banthine Rx; Used to treat intestinal and gall bladder spasms; may reduce milk supply
Anticonvulsants divalproex sodium (Depakote), phenytoin (Dilantin), carbamazepine (Tegretol) (avoid ethosuximide, phenobarbital, and primidone); AAP reports one case of Methemoglobinemia with phenytoin use; consider multiple anticonvulsants often combined which may elevate toxicity potential in infant Rx; Used for seizures and mood disorders
Antihistamines Nonsedating antihistamines (loratadine, fexofenadine, desloratadine may be preferred); sedating antihistamines like diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton) are alternatives; use lowest dose possible and at bedtime after last feeding, if possible; might have a negative effect on lactation in combination with a sympathomimetic agent such as pseudoephedrine. OTC/Rx; May reduce milk supply and cause infant drowsiness or fussiness
Antituberculars INH (isoniazid) ; nursing mothers who are taking isoniazid should take 25 mg of oral pyridoxine daily Rx; Used to treat tuberculosis
Azathioprine Imuran; avoiding breastfeeding for 4 to 6 hours after a dose will lower the dose received by the infant in breastmilk. Rx; Used to suppress the immune system following organ transplants
Bupropion Wellbutrin; little clinical data; case report of possible seizure in partially breastfed 6-month-old; another drug may be preferred. Rx; For depression
Clindamycin Cleocin; may alter infants gastrointestinal flora leading to diarrhea, thrush; topical agents unlikely to cause infant side effects Rx; Used to treat abdominal and vaginal infections
Oral decongestants pseudoephedrine (Sudafed); may cause irritability in the infant; often interferes with or reduces milk supply - do not use if lactation not well established; no information on phenylephrine so alternative may be preferred.


OTC; Used to treat congestion associated with colds or allergies
Fluconazole Diflucan Rx; Antifungal
Gadolinium
Because gadopentetate is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Rx; Contrast agent for MRI studies
Haloperidol Haldol; Limited information indicates that maternal doses of haloperidol (as monotherapy) up to 10 mg daily produce low levels in milk and do not affect the breastfed infant. Rx; Used to treat psychosis
Histamine H2 blockers Cimetidine (Tagamet), ranitidine (Zantac), nizatadine (Axid), and famotidine (Pepcid). Famotidine is preferred; cimetidine may inhibit hepatic enzymes leading to drug interactions. OTC/Rx; Used to treat stomach acid reflux/heartburn
Labetalol Normodyne, Trandate Rx; Used for high blood pressure; caution with preterm babies
Hydrochlorothiazide Doses of 50 mg daily or less are acceptable during lactation; higher doses may decrease milk production. Rx; Diuretic for high blood pressure
Lorazepam Ativan; lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines. It is safely given directly to infants, and would not be expected to cause infant problems. Rx; Used to treat anxiety
Methimazole Tapazole; may be preferred over propylthiouracil Rx; Used for hyperthyroidism; less than 20 mg/day is probably safe
Midazolam Expert panels suggest waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. Rx; Sedative used in anesthesia
Naproxen Naprosyn, Anaprox, Aleve; Because of naproxen's long half-life and reported serious adverse reaction in a breastfed neonate, other agents may be preferred while nursing a newborn or preterm infant. OTC, Rx; Used for pain relief.
Oxazepam Serax; Oxazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal doses. No special precautions are required.; however, short-term use is always preferred. Rx; Used to treat anxiety
Paroxetine Paxil; Most authoritative reviewers consider paroxetine one of the preferred antidepressants during breastfeeding. Rx; Used to treat depression
Propofol Diprivan; most experts recommend that breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse and that discarding milk is unnecessary. Rx; Sedative used in anesthesia
Propylthiouracil (PTU) It may be best to take PTU doses right after nursing and waiting for 3 to 4 hours before nursing again should minimize the infant dosage; some experts now recommend methimazole as the antithyroid drug of choice due to cases of infant liver injury with PTU.


Rx; Used to treat hyperthyroidism
Quinidine Limited information indicates that maternal doses of quinidine up to 1.8 grams daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Rx; Used to treat heartbeat irregularities
Quinolone antibacterials (i.e. ciprofloxacin) Short-term use of moxifloxacin is acceptable in nursing mothers. However, it is preferable to use an alternate drug for which safety information is available. Rx; Treatment of urinary tract infections
Sertraline Zoloft; Most authoritative reviewers consider sertraline one of the preferred antidepressants during breastfeeding. Rx; Used to treat depression
Spironolactone Aldactone, Aldactazide; spironolactone appears to be acceptable during breastfeeding. Rx; Used to treat high blood pressure
Sumatriptan injection Imitrex; Low levels of sumatriptan get into breastmilk, and sumatriptan low oral bioavailability. Withholding breastfeeding for 8 hours after a single subcutaneous injection would virtually eliminate infant exposure to the drug, and can be used in extreme cases, such as in the mother of a preterm infant. Sumatriptan would not be expected to cause any adverse effects in most breastfed infants. Rx; Used to treat migraines
Tetracyclines < 14 days; avoid prolonged or repeat courses tetracycline, doxycycline; tetracyclines have high calcium binding and low absorption in the infant; a close examination of available literature indicates teeth-staining is unlikely with short-term use, but as a caution limit to short-term use and avoid repeat treatments. Monitor for altered GI flora (diarrhea, thrush, diaper rash). Rx; Used to treat acne and urinary tract infections
Trazodone Limited information indicates that trazodone levels in milk are low and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months or when doses of 100 mg or less are used at bedtime for sleep. Rx; Used for depression and sleep
Tricyclic antidepressants (TCAs) (avoid doxepin) Amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor); some experts consider imipramine, nortriptyline two of the TCAs of choice for nursing mothers. Rx; Used to treat depression; nortriptyline preferred
Verapamil Calan, Isoptin, Verelan; Limited information indicates that maternal doses of verapamil up to 360 mg daily produce low levels in milk and newborns may have detectable verapamil serum levels, but levels are low. Verapamil would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Rx; Used for high blood pressure

Definitions:

  • RX - prescription only
  • OTC - over-the-counter

See Also...

Sources:

Last updated: January 27, 2015, L. Anderson PharmD

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