As a new parents, it's your responsibility to be knowledgeable regarding breastfeeding and drugs. Eventually, most medications do end up within the lactating mother's milk. Usually, the drug concentration in breast milk is very small and will not negatively affect the baby. Given this information, a breastfeeding woman must scrutinize the drugs she chooses to verify their safety.
Nursing and Drugs
Whether you regularly take an over the counter remedy or need a special prescription, the breastfeeding mom should consult her doctor and pharmacist before utilizing any type of drug. The pharmacist is of particular importance, as they possess the most up to date information on drug reactions. A call to your pediatrician provides excellent advice on the potential negative reactions to your infant and what side effects to look for. Typically if the drug is safe for a baby to consume, it is also safe for the nursing mother to take.
Before treating with a medical drug, there are some important factors to consider. The first is how necessary the medicine is for the woman. In every instance, the woman and her doctor will weigh the benefits to the mother verses the impact to the infant. The seriousness of the disease will lead to the decision whether medication should be administered or not.
The age of the baby also weighs heavy into this discussion. As a baby grows, so does their digestive system, lowering the risk for adverse reactions to drugs. The most critical time period is from birth to two months. If possible, try to delay consuming any drugs until after that age. Once a child is six months, the risks drop dramatically. Be particularly careful if you have a baby with special needs or premature. Partner closely with your doctor in this scenario.
The history of a drug is also another factor: the longer the history, the longer the time to complete all research and trials. Also, the type of drug and how it is administered affects the concentration in the breast milk. The sustained-release medications maintain a consistent dose leading to higher concentrations in breast milk and should be avoided if possible. Administering the drug as a pill verses an injection is also preferred for the same reasons. Timing the use of medication can reduce the absorption in the breast milk. Always take medication immediately after nursing and/or before a long stretch of sleep, if possible.
Even when a drug is highly toxic for the infant, nursing can still continue. Work closely with your doctor to find a system to postpone breastfeeding temporarily: anything from pumping milk ahead of time or temporarily pumping and dumping the milk until the drug has run its course.
With all drugs, always check with your doctor, pediatrician and pharmacist first. While most medications can be safely used while nursing, some are extremely toxic.
Acne Products: Topical creams are typically the safest, with benzoyl peroxide, clindamycin and erythromycin the best choices.
Anesthetics: Most general anesthetics are safe once the effects of the drug have worn off. For local anesthetics, the current recommendation is to wait four hours after the drug is administered before nursing.
Antibiotics: Drugs for infections typically reach the breast milk in only small quantities. Most varieties are safe but always let your doctor know you are breastfeeding and the age of your baby, as some can cause problems for young infants. While using an antibiotic and breastfeeding watch for adverse reactions in your baby such as diaper rash, thrush or diarrhea.
Anticonvulsants: As this class of medication is often long acting, breastfeeding moms should use with caution. Partner closely with your pediatrician if you are prescribed these drugs, and monitor your baby's blood to determine any negative affects on her body.
Antidepressants: As postpartum depression is common, antidepressants can be a necessity for a nursing mom. Luckily a few types are known to be particularly safe, such as amitriptline, sertralin and paroxetine. Be sure to discuss the best choices with your personal physician.
Antifungals: Clotrimazole, miconazole and fluconazole are potent, low-risk drugs used to fight yeast infections while breastfeeding.
Pain Medications: Acetaminophen and ibuprofen are the pain drugs of choice while breastfeeding. The rest should be completely avoided, including aspirin, unless absolutely necessary.
Cold and Allergy Medications: Avoid combination products to reduce the unnecessary drug exposure common in these medications. Nasal sprays are preferable to pills as they reach the milk in significantly lesser quantities. Most antihistamines are safe for the baby, but may cause a reduction in milk supply for mom. Decongestants are preferable in the nasal sprays, but pseudoephadrine in small doses, after your infant is six weeks old, is normally acceptable.
Gastrointestinal Drugs: Most drugs in this class are not absorbed into the bloodstream and therefore do not appear in breast milk. The most effective and safe versions are antacids, bulk-forming laxatives, and stool-softeners.
Sedatives: All drugs in this category will make the infant sleepy along with the mother. The safest class of sleep medications is the barbiturates as they cause only occasional drowsiness.
More Breastfeeding and Drugs
There are many reasons to avoid recreational drugs while breastfeeding that go beyond the negative affects on your baby. Trying to be a good parent while high or sedate is a difficult task. Recreational drugs consumed by a nursing woman have been shown to directly harm or cause fatalities to their infants. There are no safe levels of the following drugs, and if a woman chooses to nurse, she must also choose to remain clean.
Amphetamines: This class of drugs will inhibit the mother's milk supply and overstimulate the baby causing excessive fussiness and sleeplessness.
Cocaine: Extremely toxic to infants and can lead to excessive crying and convulsions.
Marijuana: Builds up in a woman's fat stores and can transfer to breast milk even when the mom is not actually smoking. Has been linked to delayed muscular development in infants.
Resources for Further Information
American Academy of Pediatrics Guide for Doctors - Check with your pediatrician for the recent addition containing the current research information on breastfeeding and drugs.