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Breastfeeding and Over-The-Counter Drugs

  • Deepi Brar and Nancy Montgomery
  • Posted March 11, 2013

Breast milk is the perfect food for babies. It contains all the nutrients your baby needs in just the right balance, and it passes along the natural antibodies you've acquired, too, so your little one's immune system gets off to a good start. But it can also contain some unwelcome added ingredients if you're taking medicine for a cold or other ailment.

Usually these medicines aren't passed along in large enough quantities to do harm -- experts at the Cleveland Clinic estimate that 1 percent or less of the dose you take will be contained in your breast milk. But here are some general guidelines:

  • Always check with your doctor before you take anything -- whether the medicine you're taking is from a prescription, an over-the-counter medicine you picked up at the drugstore, or an herbal remedy.
  • If you can't reach your doctor, ask the pharmacist at your drugstore. Be sure to tell your pharmacist about all the medicine or herbs you're taking, not just the one you have a question about. That way you'll know if the combination adds any risk.
  • If a medicine is commonly prescribed for infants, it's probably safe to take while nursing, because the amount the baby will get through breast milk is much less than a typical dose.
  • Check the label to see what the "active ingredient" is -- it may not be what you think. For example, Advil Cold and Sinus contains ibuprofen to help alleviate a sinus headache, but it also contains pseudoephedrine, which you may not want to take if you're nursing.
  • Take medicines either right after nursing or two to four hours before nursing. That way you won't be nursing when the medicine is at its peak in your bloodstream.
  • Don't use extra-strength or sustained-release medicines -- they remain in your bloodstream and milk supply much longer than medicine you need to take frequently. Always try to take the lowest effective dose for the shortest possible time.
  • Use single ingredient medicines rather than multi-symptom formulas whenever possible. For example, if you need a cough suppressant, don't buy one that also includes a decongestant. Read the label carefully to find out what symptoms the medicine treats, and ask the pharmacist if you have any questions.
  • When you take any medicine, watch for physical or behavioral changes in your baby. These can include sleepiness, rashes, diarrhea, or fussiness. If you notice anything unusual or worrisome, call your doctor.

Pain relievers

Acetaminophen (Tylenol) is given to babies for fever and pain relief, so is considered safe for nursing moms.

Nonsteroidal anti-inflammatories (NSAIDs) include all oral OTC pain relievers except Tylenol. The safest NSAID to take while nursing is ibuprofen (sold as Advil and Motrin) because the amount transferred to your baby is very low. Ibuprofen is also safe to give to babies in infant dosages.

Avoid naproxen (sold as Aleve, Anaprox, and other brand names) because it stays in the body for a long time and has been associated with bleeding and anemia in infants.

Avoid aspirin -- it can cause rashes and bleeding problems in nursing infants, according to the American Academy of Family Physicians. For kids up to age 18-19, using aspirin to treat high fever has been linked to Reye's syndrome, a rare but serious illness that can affect the brain and liver. It is not known whether enough aspirin passes to your baby through breast milk for Reye's syndrome to be a risk, but it's best to avoid it.

Because aspirin is often found in other medications, check the label of any over-the counter medicine you take. Surprisingly, aspirin is an ingredient in such innocuous products as Alka-Seltzer. Aspirin can also be listed as salicylate, salicylic acid, acetylsalicylic acid, or acetylsalicylate.

If you do get a prescription painkiller, talk with your doctor about any that contain codeine -- in very rare cases, it can cause life-threatening and even fatal reactions in nursing infants.

You might think that pain relievers in cream or ointment form would be safe to use, but some can prove toxic to your baby. Ointments that contain capsaicin, menthol, benzocaine, or camphor (like Tiger Balm) can be harmful if enough transfers to your baby's skin or is inhaled. Check with your doctor to find out if there is a prescription or OTC ointment that would be effective for you and safe for your baby.

Antihistamines (for allergies)

Most antihistamines have a sedating quality that even affects adults, so it's best to avoid them while nursing. Antihistamines are easily expressed in breast milk, and can cause sedation, fussiness, excessive crying, and sleep disturbances in your baby. Antihistamines may also reduce your milk production. Loratadine (Claritin) isn't as sedating as other antihistamines, so if you must take one, it is considered the preferred antihistamine for nursing mothers, according to the journal U.S. Pharmacist.

Decongestants (for stuffiness)

The two most common OTC decongestants are pseudoephedrine (found in Sudafed), and phenylephrine (ingredient in Sudafed PE and other brands). Both of these ingredients work by narrowing the blood vessels in the nasal passages. Pseudoephedrine can decrease milk production and may cause irritability in nursing babies, and the effect of phenylephrine on breast milk is unknown.

A decongestant spray may be a better bet for your stuffy nose. The medicine in a spray is less likely to be absorbed into your system than something you swallow, though it's still unclear how much of the ingredients in a spray will make it into your breast milk.

Don't use Vicks Vaporub, either, because it contains camphor. As mentioned earlier, there have been reports of camphor causing serious effects in babies, and the skin-to-skin contact while nursing may expose your baby to the cream or fumes.

To help clear up stuffiness without medicine, take a long, steamy shower, a saline nose spray, use a humidifier, or make your own steam tent by putting a bowl of hot water on a table and leaning over it with a towel held over your head and around the bowl. You can also discuss possible allergy triggers with your doctor.

Cough medicines

Cough medicines work to suppress coughs or to loosen chest congestion so you can get rid of mucus more easily when you cough. Dextromethorphan is a cough suppressant and guaifenesin is the ingredient in cough medicine that loosens mucus in the chest. Some cough medicines have both of these ingredients and others just have one. It's not clear how much of these ingredients makes it into breast milk, so ask your doctor if you're considering using cough medicine. Some cough medicines also contain alcohol, which you may want to avoid while breastfeeding.

Keep in mind that coughing is your body's way of getting rid of mucus, and sometimes suppressing it is not the way to go. Check with your doctor if your cough is bothersome. If you want to ease a cough and scratchy throat without medicine, try sipping hot tea with honey or sucking on throat lozenges or hard candies. Be sure to drink plenty of water to help keep chest and nasal secretions thin, too.

Most lozenges with menthol are safe for nursing moms because very little makes it into the milk supply. However, menthol is derived from peppermint oil, which may reduce milk supply in some women. It's probably best to avoid consuming large amounts of peppermint or menthol cough drops.

Medicines for digestive problems

When diarrhea has you running for the bathroom every time you turn around, you want fast relief. Doing your research now and putting medicines in your cabinet that you know are safe for your baby means you'll be able to grab the right remedy when you need it. The U.S. Centers for Disease Control and Prevention (CDC) recommends kaolin-pectin products (such as Kaopectate) or loperamide products (such as Imodium) for nursing mothers with diarrhea. Bismuth subsalicylate compounds (such as Pepto Bismol) contain enough aspirin ingredients that they may not be safe for your baby.

For a sour stomach or heartburn, Tums and Rolaids are safe to use. Look for the ingredients calcium carbonate or magnesium hydroxide. The heavier duty medicines that actually block acid production, called H2 blockers, contain ingredients that can be concentrated in your breast milk, so don't take them without checking with your doctor.

Medicines to treat gas and bloating, such as Gas-X, Maalox, Mylanta, and others, are safe to take. They contain simethicone, which is sometimes given to infants. It is also not absorbed into the mother's system, so wouldn't be transmitted in breast milk.

Constipation medicines

Medicines for constipation fall into two categories -- stool softeners and laxatives. Both types of medicines contain ingredients that are not well absorbed by the body, so are unlikely to make it into your breast milk. They are considered safe for nursing moms, though if your baby's stools are runnier than usual, you might want to try natural remedies instead of an OTC medicine. Eating a diet with plenty of fiber, drinking lots of water and getting exercise every day can help you avoid constipation altogether.

Antifungal medicines (for yeast or fungal infections)

Yeast infections are common in nursing moms. Many over-the-counter treatments for vaginal yeast are safe to use while nursing, since little of the medicine is absorbed into the body. Look for products containing miconazole (Monistat) or clotrimazole (GyneLotrimin). Some infants and toddlers get a similar yeast infection in their mouths (called thrush), which can then be passed to their mothers' nipples during breastfeeding. For these, consult your doctor about the best treatment.

Further Resources

National Library of Medicine: Drug and Lactation Database toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Medications and Mothers' Milk by Thomas W. Hale

References

American Academy of Family Physicians. OTC Medicines and How They Work. March 2008

Masters K, and Trompeter J. Breastfeeding and OTC Medications. U.S. Pharmacist. 2007 Jul; 32(7): 8-12. . http://www.uspharmacist.com/index.asp?show=article&page=8_2079.htm

Centers for Disease Control and Prevention. Food-borne and waterborne illness during breastfeeding. May 22, 2007. http://www.cdc.gov/breastfeeding/disease/illness.htm

Mayo Clinic. Reye's syndrome. September 2007. http://www.mayoclinic.com/health/reyes-syndrome/DS00142.

Topical NSAIDs: plasma and tissue concentrations. Bandolier journal. http://www.medicine.ox.ac.uk/bandolier/booth/painpag/topical/topkin.html

Camphor. The International Programme on Chemical Safety (IPCS). http://www.inchem.org/documents/pims/pharm/camphor.htm

National Institutes of Health. Peppermint (Mentha x piperita L.) Medline Plus. January 1, 2008. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-peppermint.html

Richter JE. Review article: the management of heartburn in pregnancy. Alimentary Pharmacology and Therapeutics. Otober 25, 2005

Mayo Clinic. Oral Thrush. August 2007. http://mayoclinic.com/health/oral_thrush/DS00408/DSECTION=causes

Over-the-Counter Medications and Breastfeeding. Cleveland Clinic. http://my.clevelandclinic.org/healthy_living/breastfeeding/hic_over-the-counter_medications_and_breastfeeding.aspx

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