Breastfeeding & Over-the-Counter Medications

Is it safe to take over-the-counter medicines while I am breastfeeding my baby?

The answer is usually "yes." To provide some simple background information about this topic, briefly, here are some known facts about medicine and breast milk:

• Nearly all medicines taken by a mother pass into human milk, BUT only in very small amounts--usually less than one percent of the dosage taken by the mother.
• Because only a very small amount even passes into milk, there are very few drugs that SHOULDN’T be taken by a nursing mother.
• IN MOST CASES, nursing mothers do not need to interrupt breastfeeding to take prescription or over-the-counter medicines. In the rare situation when you should not take a drug, you may try an alternative drug, a non-drug, or a procedure.

Two simple general rules that can help you determine if it is safe to take a medicine during breastfeeding are:

• If a drug is commonly prescribed for infants, it is likely safe to take while nursing, since the baby would generally receive a lower dose from breast milk than from taking the drug directly.
• Drugs considered safe to take during pregnancy are, with few exceptions, safe to take while nursing.

Are there any additional safety measures to consider while breastfeeding?

Even though most medicines are safe to take during breastfeeding, some additional safeguards to lower any potential risk even further include:

• Only take a medicine if you REALLY need it. Consider alternative non-drug therapies, if possible.
• Take the lowest possible dose for the shortest possible time.
• Avoid extra-strength formulas. Also avoid "sustained-release" preparations and medicines taken only once or twice a day. These are considered "long acting" drugs and remain in the mother’s blood stream and milk supply much longer than drugs that need to be taken more frequently.
• When possible, use single ingredient preparations rather than multi-symptom formulas. For example, if you only have a cough, use a single-ingredient cough suppressant rather than a cough suppressant combined with a decongestant.
• Watch for signs of a possible drug reaction in your baby such as sleepiness, rashes, diarrhea, or colic. Although such reactions rarely occur, call your healthcare provider if you see such changes.
• Finally, always read the medicine labeling and package insert for any precautions or warnings about taking the drug while breastfeeding. Never hesitate to call your doctor, the baby’s pediatrician, a lactation consultant, or your pharmacist if you have any concerns about taking a medicine while you are breastfeeding.

Which medicines are NOT safe to take while breastfeeding?

Some of the medicines that require temporary weaning are those that contain radioactive compounds and drugs used to treat cancer. Most of the drugs that raise any concern at all are prescription drugs, not over the-counter medicines.

For more information on unsafe medications that are geared to nursing mothers, please go to the United States National Library of Medicine, LactMed, which contains over 450 drug records.

If I am a smoker, can I continue to smoke and breastfeed?

Of course, the best choice for your personal health and the health of your baby is to quit smoking. However, if you can’t quit, try to cut down. If you smoke less than a half a pack a day, the risks to the baby are small. Of course, the fewer cigarettes you smoke, the smaller the chance of encountering problems. Nicotine in large doses can cause low milk supply, a poor letdown reflex, and GI upset in some babies (for example, resulting in nausea/vomiting, abdominal cramps, and diarrhea). If you must smoke:

• Don’t smoke around the baby, and smoke after you nurse.
• Wash hands and face after smoking.
• Cover your hair and change your clothes.
• Do not smoke indoors.

Can I safely drink alcohol while breastfeeding?

Occasional or light drinking—such as a glass of wine or a beer—has not been found to be harmful to a breastfeeding baby. Erring on the conservative side, wait at least two hours for every drink you consume before nursing your baby. Or alternatively, use expressed milk to feed your baby after consuming alcohol.

Also, consider choosing drinks low in alcohol content or that are diluted with water or juice.

Moderate-to-heavy alcohol consumption by a breastfeeding mother has been shown to interfere with the let-down reflex, inhibit milk intake, affect the baby’s motor skill development, slow weight gain, inhibit growth, and cause drowsiness in the baby.

Can I safely drink coffee while breastfeeding?

Drinking up to two 5-ounce cups of coffee per day does not appear to cause any problems for a mother and nursing baby. Drinking more than this amount can result in an irritable or fussy baby and a baby with poor sleeping habits. Some babies are sensitive to any amount of caffeine.

Remember to consider the amount of caffeine you drink from ALL of your beverages, including coffees, teas, colas, and even chocolate. Consider cutting back or switching to decaffeinated beverages.

Please consult your healthcare provider for advice.