The American Academy of Pediatrics recommends that women breastfeed their newborn infants, when possible, because breastfeeding provides many benefits to the feeding infant and the mother. Human breast milk contains an excellent balance of nutrients and provides additional benefits to the infant, including protection from many types of infection, such as ear infections, diarrhea, and meningitis. Breast milk contains natural antibodies from the mother that decrease the risk of these infections to the infant, and possibly other types of infections as well. Breastfeeding also plays a role in decreasing the risk of sudden infant death syndrome (SIDS) and may decrease the risk of your infant’s developing allergies or asthma.
Breastfeeding additionally benefits the mother. The hormones prolactin and oxytocin are released during breastfeeding. These hormones provide a natural feeling of maternal relaxation and maternal-infant bonding and help the mother’s body recover and heal from pregnancy and childbirth. Prolactin and oxytocin also delay the return of a mother’s menstrual period and decrease a risk of ovarian and breast cancer later in the mother’s life.
Most medicines are safe to use while breastfeeding, because the amount of medicine that distributes into breast milk is a small and clinically insignificant amount and is unlikely to be of danger to a feeding infant. However, some medicines do distribute into breast milk to a greater extent and may be of potential concern for the baby’s health. For some medicines, especially newer medicines, we do not have enough information to assess if a mother’s use of the medicine is clinically significant for her baby’s health.
You can search a medically accurate and reliable Internet site called LactMed at http://toxnet.nlm.nih.gov to find information about a specific medicine’s use while breastfeeding. This Internet site, from the National Institutes of Health, is updated monthly and is the largest online source of information about maternal medicine use and breastfeeding. It is easy to search for specific medicines and what is known about their effects on an infant.
The amount of a medication that distributes into breast milk depends upon several factors, including how much medication is absorbed by the mother, how the mother metabolizes the medication, chemical characteristics of the medication, the amount of breast milk taken by the infant, the age of the infant, and other factors. The type of medicine (that is, how it functions in the body) and its adverse effect profile are important as well. An additional consideration when thinking about taking medicines while breastfeeding is the effect of the medication on milk production, because some medications can reduce the amount of milk the mother produces.
Many medicines can be safely taken by a woman while breastfeeding her infant. Commonly used medicines considered safe while nursing include the following, which are only several examples of medicines considered safe to use while breastfeeding:
• acetaminophen (Tylenol and generic)
• ibuprofen (Motrin, Advil, and generic)
• loratadine (Claritin and generic)
• cetirizine (Zyrtec and generic)
As with all medicines taken by a mother who is breastfeeding her infant, it is best to use the medicine at the smallest dose possible to control the illness or symptoms, and to take the medicine for the shortest time period possible.
To minimize the amount of medicine that distributes into breast milk consider following these suggestions:
• Take the medicine at a time when you are not as likely to be breastfeeding your infant. For example, take your medicine just after you have breastfed your infant or when you expect your infant to sleep for several hours. This allows the medicine to reach its highest concentration in your blood and milk when your infant will not be breastfeeding.
• Use “short-acting” medicines when possible. Some medicine products are made to last longer, so they can be taken only once or twice per day. Many of these medicines are also available as short-acting products, which means that they often need to be taken three or more times per day. These short-acting products don’t stay in the bloodstream as long, which is preferred when you are breastfeeding.
• Always closely watch your infant for any change in behavior if you are taking medicine and breastfeeding. For example, if your infant is sleeping much more, or less, since you started taking a medicine, it is possible that some of the medicine is getting into your milk and affecting your infant.
Some antidepressant medicines, such as the selective serotonin reuptake inhibitors (SSRIs) discussed in chapter 4, are commonly used by adults and deserve careful consideration if a mother would like to breastfeed her infant. Some SSRI medicines may distribute into breast milk to a clinically significant amount and may produce adverse effects in the infant. Although some information is known about antidepressant medicines distributing into breast milk, the long-term effects on an infant’s development are still unknown. Many antidepressant medications and similar medications used to treat anxiety or mood disorders distribute into breast milk to some extent, although we do not know how much for many medications. Case reports have been published documenting blood levels of some antidepressants, such as fluoxetine (Prozac and generic), distributing from swallowed breast milk into infants’ blood to about 10 percent of the blood level of the mother. This amount may be clinically significant and may result in adverse effects in the infant. The long-term effects of these medications on the developing brain chemistry of infants are unknown.
Concerns have additionally been raised about the use of several herbal products during breastfeeding, including echinacea and St. John’s wort. Current recommendations are to avoid these herbal products and possibly other herbal products during breastfeeding. Very little information is known about the use of herbal products by a mother while breastfeeding.
If you desire to breastfeed your infant and you are taking any medicines, including over-the-counter products and herbal products, it is best to inform your pediatrician and discuss the safety of using these medicines while breastfeeding and the potential for adverse effects in your infant.