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Safe Medication Use During Breastfeeding

Medically reviewed by L. Anderson, PharmD. Last updated on May 23, 2019.

Please Note: Always consult your doctor or healthcare specialist for medical advice in relation to drug use while pregnant or breastfeeding. Prescribing should be made on a case-by-case basis, and information may not be applicable to every situation.

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 of breast and ovarian cancers.

Exclusive breastfeeding is recommended for at least 6 months by most experts, and extended to 12 months while introducing other foods. However, many mothers will need to take medications of some type during breastfeeding, whether it be short-term for a sore back or a runny nose, or longer-term for a chronic condition like high blood pressure. 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.

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 pediatrician before taking any kind of prescription or over-the-counter medication, herbal or dietary supplement, or vitamin. Even herbal teas may contain ephedra or other harmful ingredients. Just because a label says "natural" does not always mean it's safe.

Breastfeeding and Medication Tips

  • The American Academy of Pediatrics states that many effects of medications on breastfeeding babies simply are not known. Due to this, only take a medication when absolutely needed, at the lowest dose and for the shortest time possible.
  • 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.
  • Watch your baby for side effects such as sleepiness, irritability, other potential or known reactions of the medication.
  • Avoid long-acting (LA), extended-release (ER), and combination forms of medications, when possible. Shorter-acting medications are elimninated from your body more quickly, and single medications give you greater flexibility in dosing.
  • Special precautions may be needed in preterm (premature) infants, due to their size and organ systems that are even less developed than a regular term infant.
  • Ask your doctor about the risks and benefits of any medication prescribed while you are breastfeeding, or any medication you choose from OTC options that do not require a prescription.
  • When more than one medication or a combination medication is used, follow the breastfeeding recommendations for the most problematic medication.

If you have more questions about how a drug you're taking might affect your breast milk or your baby, you can also check our pregnancy warnings and breastfeeding warnings pages.

Table 1: 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
acyclovir and valacyclovir Zovirax, Valtrex Rx; antiviral for herpes infections
Antacids (aluminum, magnesium) Maalox, Mylanta

OTC; stomach upset (dyspepsia)

The World Health Organization (WHO) considers compatible with breastfeeding.

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 or ibuprofen may be safer for pain relief.

Some 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.

Avoid high-dose, long-term use of aspirin, if possible.

bupivacaine Marcaine Rx; a local anesthetic used in labor/delivery
caffeine

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

A stimulant that DOES pass into breast milk.

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

Avoid concentrated energy drinks, pure caffeine tablets.

Caffeine consumption of 300 mg per day max suggested (2 to 3 cups of coffee).

Caffeine levels from breast milk may be higher in preterm infants.

Cephalosporins (i.e. Keflex or cephalexin)

Most cephalosporins are considered compatible with breastfeeding.

Rx; broad-spectrum antibiotics for infections.

According to the American Academy of Pediatrics (AAP), in general, an antimicrobial agent is safe to administer to a lactating woman if it is safe to administer to an infant.

May interfere with gut flora in infant leading to diarrhea or thrush.

clotrimazole

Clotrimazole (troches or topical)

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

Poor oral bioavailability, unlikely to adversely affect the breastfed infant.

Contraceptives (progestin-only norethindrone)

Brand name examples: Ortho MicronorErrin, Heather, others.

Rx; used for birth control.

Generic, lower cost versions of norethindrone are available.

Estrogen may lower milk production and protein content.

Nonhormonal methods are preferred during breastfeeding; however, progestin-only contraceptives such as norethindrone are considered the hormonal contraceptives of choice during lactation.

Corticosteroids

Examples: prednisone, prednisolone.

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

As reported by ToxNet database, no adverse effects have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding.

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

OTC; Used to treat stuffy noses.

Limited systemic absorption.

Recommended over oral decongestants, which may inhibit milk production.

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; macrolide used for skin and respiratory infections.

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

fexofenadine Allegra Allergy OTC; non-drowsy antihistamine for allergies and hay fever.
fluconazole Diflucan

Rx; Used to treat yeast infections

Acceptable in nursing mothers because amounts in breastmilk are less than infant dose.

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.

ibuprofen Motrin, Advil Rx/OTC: used for pain relief
Inhaled bronchodilators albuterol, terbutaline

Rx; used for asthma.

  • No published data.
  • Use of inhaled bronchodilators acceptable due to low bioavailability and maternal serum levels after use.
insulin Mothers with diabetes using insulin may nurse their infants. 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.

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.

Laxatives, bulk-forming and stool softening. Metamucil (psyllium), Colace (docusate)

OTC; used to treat constipation.

Low to minimal absorption.

lidocaine Xylocaine

Rx; a local anesthetic.

Lidocaine is poorly absorbed by newborns.

Lidocaine is not expected to cause side effectds in breastfed infants.

loratadine Claritin, 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.

Low molecular weight heparins (enoxaparin, dalteparin) Lovenox, Fragmin Rx; used as an anticoagulant; not expected to be excreted into breastmilk due to high molecular weight.
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.

See Dosage comments.

methyldopa   Rx; used to treat high blood pressure; no special precautions needed.
metoprolol Lopressor Rx; a beta-blocker used to treat high blood pressure; no special precautions are required.
miconazole (topical use) Monistat

OTC; used to treat yeast infections.

Poor oral bioavailability. Unlikely to affect the breastfed infant, including topical application to the nipples; but rarely prescribed.

nifedipine Adalat, Procardia

Rx; used for high blood pressure and Raynaud's syndrome (painful nipple vasospasm).

Limited data suggests no or minimal risk to infant.

Penicillins amoxicillin, penicillin G

Rx; used to treat bacterial infections.

Amoxicillin, penicillin G are acceptable in nursing mothers.

propranolol Inderal LA, Inderal XL, InnoPran XL 

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

AAP considers compatible with breastfeeding; monitor infant for respiratory depression, low heart rate and low blood sugar.

theophylline

Elixophyllin, Theo-24, others

Rx; used to treat asthma and bronchitis.

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

Delay nursing for 2 to 4 hours after dose if possible, but may not matter if taking long-acting forms.

tretinoin topical Avita, Atralin, Renova, Retin A

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

Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. 
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 is a normal component of breast milk. Use is considered acceptable.

Vaccines (except smallpox and yellow fever vaccines)

Breastfed infants should be vaccinated according to routine established schedules from the ACIP.

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.

vancomycin (oral) Vancocin, Firvanq

Rx; oral antibiotic.

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.

verapamil Calan, Calan SR, Verelan, Verelan PM

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

Data are limited but suggest that maternal doses of verapamil up to 360 mg daily produce detectable, but low levels in milk.

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

warfarin Coumadin

Rx; used to treat or prevent blood clots.

Very low milk levels occur with warfarin doses up to at least 12 mg daily.

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

There is a consensus that maternal warfarin therapy during breastfeeding poses little risk to the breastfed infant. No special precautions are needed.

Rx - prescription only; OTC - over-the-counter

Table 2: Other Common Medications Used in Breastfeeding

In general, data is limited for the effects of these drugs on a breastfeeding infant. Follow the links to learn more about use of these drugs in breastfeeding and always check with your doctor. Added monitoring or laboratory testing may be required for the infant. Prescribing is made on a case-by-case basis by your healthcare provider.

Drug or Class Brand or Generic Name Notes
ACE inhibitors

captoprilenalapril (Vasotec), benazepril (Lotensin)

Rx; used to treat high blood pressure, kidney conditions, heart disease.

Low levels of ACE inhibitors such as captopril, enalapril and benazepril can appear in breast milk. However, amounts ingested are small and would not be expected to cause any adverse effects in breastfed infants.

Anticonvulsants

Reported as possibly safe, monitor baby for side effects:

Cautious use advised; risk possible or limited data; monitor infant more closely for side effects:

Do not use, or use with extreme caution and monitor infant as recommended by a healthcare provider:

Rx; used for seizures and mood disorders. Pregnant and breastfeeding women with epilepsy should always consult their health care provider about appropriate seizures medications.

Check individual drugs as certain medications can be hazardous to nursing infants, while others may be more safe.

Treatments for epilepsy are often used in combination. Use of two or more seizure drugs may lead to worsened or unexpected side effects.

Antihistamines

Nonsedating antihistamines are usually preferred.

Sedating antihistamines are alternatives for short-term, low dose use.

OTC/Rx; Antihistamines may reduce milk supply (especially when used with a decongestant) and cause infant drowsiness or fussiness.

Use lowest dose possible and take at bedtime after last feeding.

INH (isoniazid)

Nydrazid

Rx; used to treat tuberculosis

Nursing mothers who are taking isoniazid should take 25 mg of oral pyridoxine daily.

Monitor infants for rare instances of jaundice.

azathioprine

Imuran

Rx; used to suppress the immune system following organ transplants.

Most experts consider breastfeeding during azathioprine to be acceptable.

Avoid breastfeeding for 4 to 6 hours after a dose.

bupropion

Aplenzin, Budeprion XL, Wellbutrin XL, Zyban

Rx; for depression, seasonal affective disorder, smoking cessation.

Clinical data is lacking; case report of possible seizure in partially breastfed 6-month-old; another drug may be preferred.

Monitor infant closely if combined with an SSRI.

clindamycin

Cleocin

Rx; Used to treat abdominal and vaginal infections.

Oral or IV product may alter infants gastrointestinal flora leading to diarrhea, thrush, rarely blood in stool; consider alternative.

Topical agents unlikely to cause infant side effects.

Oral decongestants

 

 

 

phenylephrine, pseudoephedrine (Sudafed)

 

OTC; Used to treat congestion associated with colds or allergies.

May cause irritability in the infant; often interferes with or reduces milk supply - do not use if lactation not well established.

Limited information on oral phenylephrine so alternatives may be preferred.

Phenylephrine nasal spray or ophthalmic drops are less likely to lower milk production.

fluconazole

Diflucan

Rx; antifungal.

Fluconazole is acceptable in nursing mothers because amounts excreted into breastmilk are less than the neonatal fluconazole dosage.

gadopentetate

Magnevist

Rx; Contrast agent for MRI studies.

Because gadopentetate is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause adverse effects in breastfed infants.

haloperidol

Haldol

Rx; used to treat psychosis.

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.

Histamine H2 blockers

OTC; used to treat stomach acid reflux/heartburn.

Famotidine is preferred; cimetidine may inhibit hepatic enzymes leading to drug interactions.

labetalol

Trandate

Rx; used for high blood pressure.

Caution with preterm babies; other agents may be preferred.

hydrochlorothiazide

Microzide

Rx; diuretic for high blood pressure.

Doses of 50 mg daily or less are acceptable during lactation; higher doses may decrease milk production.

lorazepam

Ativan

Rx; used to treat anxiety, seizure disorders.

Lorazepam has low levels in breastmilk, and a short half-life compared to some benzodiazepines.

It is safely given directly to infants, and would not be expected to cause infant problems. No reports list sedation in infants at normal maternal doses.

methimazole

Tapazole

Rx; used for hyperthyroidism (high thyroid levels).

Less than 20 mg/day is probably safe.

When possible, take methimazole immediately after nursing and wait for 3 to 4 hours before nursing again.

No cases of thyroid dysfunction have been reported in nursing infants.

Some experts preferred over propylthiouracil

midazolam

Versed

Rx; sedative used in anesthesia.

Not expected to cause adverse effects in most breastfed infants.

Expert panels suggest waiting for at least 4 hours after a single IV dose of midazolam before nursing.

naproxen

 

Anaprox, Aleve, Naprosyn

OTC/Rx; used for pain relief.

Limited data suggests that naproxen levels in breastmilk are low and side effects in breastfed infants are uncommon.

However, because of naproxen's long half-life and reported serious adverse reaction in a breastfed newborn, other NSAIDs (i.e., ibuprofen) or acetaminophen may be preferred while nursing a newborn or preterm infant.

oxazepam

Not available

Rx; used to treat anxiety.

Low levels in breast milk. Oxazepam is not expected to cause any side effects in breastfed infants with usual maternal doses.

No special precautions are required; however, short-term use is always preferred.

propofol

Diprivan, Propoven

Rx; general anesthetic used in surgery or other procedures.

Amount in milk are small and not expected to cause infant side effects.

Most experts recommend that breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia. Discarding milk is unnecessary.

propylthiouracil (PTU)

Not available

Rx; used to treat hyperthyroidism

Take PTU doses right after nursing and wait 3 to 4 hours before nursing to minimize the infant dosage.

Some experts now recommend methimazole as the antithyroid drug of choice due to theoretical risk of infant liver injury with PTU.

quinidine Not available

Rx; used to treat heartbeat irregularities.

Limited data suggests that maternal doses of quinidine up to 1.8 grams daily produce low levels in milk.

Not expected to cause side effects in breastfed infants, especially if the infant is older than 2 months.

Select quinolone antibacterials 

ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox)

Rx; treatment of urinary tract infections unresponsive to other antibiotics.

Short-term use of ciprofloxacin, levofloxacin, or moxifloxacin, appears to be acceptable in nursing mothers. However, due to serious side effects in patients, the FDA has stated that they are not suitable for common conditions such as sinusitis, bronchitis, and uncomplicated urinary tract infections.

Quinolones should only be used when treatment with other appropriate antibiotics has failed.

Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, studies indicate little risk.

Avoiding breastfeeding for 3 to 4 hours after a dose should decrease the exposure of the infant.

Ophthalmic preparations pose little risk to a nursing baby.

SSRIs

 

Paxil (paroxetine), Zoloft (sertraline)

Rx; used to treat depression.

Most newer antidepressants produce very low or undetectable plasma concentrations in nursing infants. Shorter half-life agents may be preferred.

Most authoritative reviewers consider paroxetine or sertraline preferred antidepressants during breastfeeding.

Paroxetine has not been detected in serum of most infants that were tested.

spironolactone

 Aldactone

Rx; used to treat high blood pressure

Spironolactone appears to be acceptable during breastfeeding.

sumatriptan

Imitrex

Rx; used to treat migraines

Sumatriptan has low oral bioavailability with low milk levels.

Experts and labeling suggest to withhold breastfeeding for 8 hours (12 hours from manufacturer).

Sumatriptan would not be expected to cause any adverse effects in most breastfed infants.

Tetracyclines

Vibramycin (doxycycline)

Rx; used to treat acne and urinary tract infections

Tetracyclines like have high calcium binding and low absorption in the infant, due to calcium binding in milk.

As a caution limit to short-term use and avoid repeat treatments due to possible teeth staining.

Monitor for altered intestinal tract flora (diarrhea, thrush, diaper rash).

trazodone Not available

Rx; used for depression and sleep

Limited data shows that trazodone milkk levels are low.

It would not be expected to cause any side 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.

Tricyclic antidepressants (TCAs)

 

imipramine (Tofranil), nortriptyline (Pamelor)

Rx; used to treat depression.

Some experts consider imipramine, nortriptyline the TCAs of choice for nursing mothers, if a TCA must be used. Low milk levels and few side effects reported in infants.

Avoid doxepin due to active metabolite, presence in infant serum, and reported side effects. Avoud clomipramine due to possible heart defects.

Rx - prescription only; OTC - over-the-counter

Drugs to Avoid Use in Breastfeeding

As reported by the American Academy of Pediatrics (AAP), concerns exist for amiodarone (Pacerone), anticancer drugs, chloramphenicol, ergotamine, gold salts, phenindione, radioactive pharmaceuticals, retinoids, tetracyclines (chronic > 3 weeks) and certain psychotropic medications. These drugs shoud not be used during breastfeeding.

Lithium now can be taken with careful monitoring of blood levels in mother and baby.

See Also

Sources

  1. Vaccination Safety for Breastfeeding Mothers. US Centers for Disease Control and Prevention (CDC). Jan 24, 2018. Accessed May 19, 2019 at https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/vaccinations.html
  2. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011 Feb; 7(1): 28–34. Accessed May 23, 2019 at doi: 10.2174/157340411794474784
  3. FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration (FDA). Press Announcements. Accessed May 23, 2019 at https://www.fda.gov/news-events/press-announcements/fda-updates-warnings-fluoroquinolone-antibiotics-risks-mental-health-and-low-blood-sugar-adverse

  4. Clinical Report: The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796-e809. Available at: http://pediatrics.aappublications.org/content/132/3/e796. Reaffirmed May 2018 

  5. Mother to Baby. Organization of Teratology Information Specialists. Accessed May 20, 2019 at https://mothertobaby.org/fact-sheets/valproic-acid-pregnancy/
  6. Davanzo R, Dal Bo S, Bua J, et al. Antiepileptic drugs and breastfeeding. Ital J Pediatr2013; 39: 50. Accessed online May 20, 2019. doi: 10.1186/1824-7288-39-50

  7. Hale's Medication and Mother's Milk. Online. 2019. Springer Publishing Company. Accessed May 20, 2019 at https://www.halesmeds.com/categories
  8. National Institutes of Health. US National Library of Medicine. Toxnet. LactMed database. Accessed January 25, 2015 at http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm

  9. Thomas J. Medications and Breastfeeding: Tips for Giving Accurate Information to Mothers. American Academy of Pediatrics. Accessed online May 21, 2019 at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/Medications-and-Breastfeeding.aspx
  10. Healthy Children.org. Medications and Breastfeeding. Updated 11/23/2014. Accessed May 21, 2019 at http://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Medications-and-Breastfeeding.aspx
  11. Drugs.com. Medicine use while Breastfeeding. May 21, 2019. Accessed at https://www.drugs.com/breastfeeding/
  12. American Academy of Pediatrics: The Transfer of Drugs and Other Chemicals Into Human Milk. Committee on Drugs. Pediatrics 2001; 108:3 776-789. Accessed January 25 at https://pediatrics.aappublications.org/content/108/3/776

Further information

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

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