Breastfeeding and drugs: a mother's guide

Only if you really need it.
• If you have a choice, delay the start time until your baby is older.
• Take the lowest possible dose for the shortest possible time.
• Avoid 'sustained release' drugs.
• Schedule the doses so that the lowest amount gets into the milk - taking it soon after feeding, preferably a night feed.
• Watch for any reaction/side effects: mothers are often not informed, and do not realise, that diarrhoea, constipation, sedation or weakness may be a medication problem. Being forewarned will safeguard the baby.

Drugs guide

• Corticosteroids have been safely used in breastfeeding mothers for many years.
• Most antibiotics are safe.
• Combined oral contraceptives (containing an oestrogen plus a progestogen) are contraindicated.
• Progesterone-only pills are safe.
• Antidepressants are used with caution. A balance has to be made between the needs of the breastfeeding mother against the possible adverse effects on the infant. These drugs have not been investigated in a controlled and systematic way; there are single case reports and confoundable data, and this makes guidelines difficult.
• Lithium is not safe.
• Antiepileptics have not been proven unsafe.
• Oral anticoagulants (blood-thinning agents) appear safe.
• All illegal drugs of abuse (such as cannabis, heroin, cocaine) are contraindicated.
• Methadone maintenance programmes need not be discouraged as the exposure of the breastfeeding infant is minimal.
• Anything applied to the nipple is likely to be absorbed by the baby, so caution is necessary.
• Insulin is one of the drugs that is 'too big' to get into breast milk and is therefore safe.
• Caffeine, in the form of coffee, tea or cola, does not seem to bother most babies - as long as the amounts are not excessive, at which point the infant may become wakeful and crabby!
• Vaccines are safe; some reports show that breastfeeding has also improved the vaccine responses. Several studies have shown that milk may actively stimulate the immune system of the infant. This also includes the influenza vaccine, which does not affect the safety of the breastfeeding mother or the baby.
• Specific drugs known to concentrate in breast milk: these can cause a marked toxic effect in the feeding baby. Your own doctor will be aware of these and will advise.
• Most chemotherapy drugs (for cancer treatments) are contraindicated.
• Smoking: nicotine can cause vomiting and diarrhoea and the baby may become restless and agitated. It is therefore best that the mother who is breastfeeding should not smoke; it has been demonstrated that milk production is decreased by smoking.

The final verdict

Human breast milk is impossible to duplicate. A mother's body can provide exactly what her breastfeeding baby needs just as and when he or she needs it.

Breast milk substitutes do not change to meet the baby's nutritional, immunological or developmental needs and lead to poorer-quality nutrition, more infections and allergic illnesses.

So, breastfeeding with just a little drug in the milk is almost always safer. In other words, being careful usually means continuing breastfeeding.

Discontinuation because of medications is usually not advisable, most acute and chronic diseases being effectively treated without having to sacrifice the well-documented and extensive benefits of breastfeeding for both mother and baby.

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