Can You Take Over-the-Counter Medications While Breastfeeding?

When it comes to our health, we should be conscientious about what we put into our bodies — after all, what we consume has a direct impact on our overall health. But that practice is especially true for nursing parents who are breastfeeding (chestfeeding) their babies or pumping their breast milk to bottle-feed their newborns.

We know it’s best to quit smoking while breastfeeding because smoking cuts down on the supply of breast milk and has a negative impact on babies. But what about over-the-counter medications? Can the drugs you take for other health conditions seep into your breast milk and be passed on to your child? And do you need to cut back on any dosage recommendations to protect your baby?

Pediatrician and breastfeeding medicine specialist Heidi Szugye, DO, IBCLC, shares the good news about common medications you might be taking, along with which medications to avoid while breastfeeding.

Does medicine pass through breast milk to your baby?

Only a very small amount of nearly all medications taken by a nursing parent pass into their human milk. In most cases, just less than 1% makes it through to the final product. That means, with few exceptions, nursing parents can continue taking their medications, including most over-the-counter ones because the amount your baby consumes is not nearly enough to affect them.

“The amount of medication that actually gets in the breast milk, for most medications, is usually so little,” says Dr. Szugye. “Some of it is even broken up by the acidic contents of the stomach and the baby so that often, by the time it reaches the baby’s bloodstream, it’s so minimal.”

When considering medications that are safe to take, eight general rules apply:

1. If a medication is commonly prescribed for infants, it’s likely safe to take while nursing, as your baby would generally receive a lower dose from breast milk than from taking the medication directly.
2. Medications considered safe to take during pregnancy are, with few exceptions, also safe to take while nursing.
3. Only take a medicine if you really need it. Consider alternative non-drug therapies, if possible.
4. Take the lowest possible dose for the shortest possible time.
5. Avoid extra-strength formulas. Also, avoid “sustained-release” or “extended-release” preparations and medicines taken only once or twice a day. “These are considered ‘long-acting’ drugs and remain in the mother’s bloodstream and milk supply much longer than drugs that need to be taken more frequently,” warns Dr. Szugye.
6. When possible, use single-ingredient medications rather than multisymptom formulas. For example, if you only have a cough, use a single-ingredient cough suppressant rather than a cough suppressant combined with a decongestant.
7. Always read the medicine label and package insert for any precautions or warnings about taking the drug while breastfeeding.
8. 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’re breastfeeding.

“In general, you shouldn’t assume something is safe or not safe,” advises Dr. Szugye. “You should always reach out to your healthcare provider if you have any specific questions or concerns. There are also a lot more resources out there than ever that can be really helpful.”

Some helpful resources include:

• LactMed®: The Drugs and Lactation Database (LactMed) is an expansive database that indexes medications and other chemicals that breastfeeding parents have been exposed to. The index includes the levels of substances that have been found in breast milk and infant blood, along with safer alternatives for those medications that have proven to be unsafe. Each entry is also listed alongside peer-reviewed medical research and scientific literature for reassuring context.
• The InfantRisk Call Center and MommyMeds App: The InfantRisk Call Center (1.806.352.2519) is designed to provide you with answers to any questions about breastfeeding and the medications you’re taking.
  The MommyMeds app also allows you to search for more than 20,000 drugs and medications and has a barcode scanning capability for quick-and-easy guidance for last-minute medication advice.
• Trash the Pump and Dump: This online resource, run by a clinical professor and a board-certified family medicine physician, busts several myths about breastfeeding by providing instructions on when to throw out breast milk and when it’s safe to use.

“Some medications will potentially decrease your breast milk supply, so that’s something to think about,” notes Dr. Szugye. “There are also some medications that we need to be cautious of and monitor the baby for possible side effects, but for the most part, many over-the-counter medications are safe.”

Specific signs and symptoms of negative side effects to look out for include:

• Changes to your baby’s mental status.
• Skin changes like rashes, irritation and redness.
• Increased fatigue and sleepiness.
• Dehydration.
• Diarrhea.
• Colic.

“If your baby is acting more lethargic, they’re not waking up for feedings or not feeding well, or their diapers are less wet than usual, those are all red flags that your baby needs some medical attention,” warns Dr. Szugye.

What can you take for pain relief while breastfeeding?

Most over-the-counter pain medication is safe for the infant if it’s safe for the nursing parent during pregnancy, including:

• Acetaminophen (Tylenol®).
• Ibuprofen (Advil®, Motrin®).
• Naproxen (Aleve®).

But ibuprofen and naproxen should be avoided in infants with congenital heart disease. Talk to your healthcare provider regarding pain management and any prescription pain medicine that you have to see whether or not it’s safe.

In some cases, low doses of oxycodone or hydrocodone are safe when used for short-term pain relief while breastfeeding, but you should avoid medications or formulas that contain codeine if possible. Many adults can be slow or rapid metabolizers of codeine which may increase the possibility of side effects in your baby.

What cold medicines are safe while breastfeeding?

Most cold medicines are safe while breastfeeding, especially if you take them short term and only when you need them. Some of the medications that are safe include:

• Expectorants that contain guaifenesin (Mucinex®, Robitussin® and others).
• Cough suppressants that contain dextromethorphan (DayQuil®, Delsym® and others).

Remember, cold medications often have multiple-ingredient formulas to address multiple symptoms, so you want to be careful not to double up on ingredients and only take these sparingly.

The cold medications you should avoid are the ones that include pseudoephedrine (Sudafed®) or phenylephrine (Neo-Synephrine®) — both oral and nasal preparations — as they can decrease milk supply.

“Even just one dose of 60 milligrams of Sudafed can cut the supply of breast milk by 25%,” states Dr. Szugye. “We actually use Sudafed for nursing parents that have an over-supply of breast milk to decrease their supply to relatively normal levels.”

Most antibiotics (including some types of penicillin, like amoxicillin and ampicillin) are safe with breastfeeding, but you should always tell your physician if you’re breastfeeding before taking any antibiotics. Some antibiotics should be avoided in infants with jaundice, in the first weeks of life, and if they were born preterm.

Can you take allergy medications while breastfeeding?

Second-generation allergy medications and antihistamines are also safe to take while breastfeeding, including:

• Cetirizine (Zyrtec®).
• Fexofenadine (Allegra®)
• Fluticasone (Flonase®).
• Loratadine (Claritin®).

Although generally considered safe to use, first-generation allergy medications like diphenhydramine (Benadryl®) can cause sedation in infants and decrease milk supply, so you want to avoid anything that might cause drowsiness in you or your infant.

What about prescription medications?

The safety of prescription medications vary widely based on the kind of medication, dose, frequency and how long you’ve been taking it. Medications you’ll want to discuss with your healthcare provider include:

• Birth control: Birth control is safe to use while breastfeeding, but estrogen-containing birth control can affect your milk supply. “We typically recommend using progesterone-only birth control and waiting usually until four weeks postpartum until your milk supply is established,” says Dr. Szugye. This should be discussed with your Ob/Gyn provider shortly after delivery.
• Antidepressants, anti-anxiety medication and antipsychotics: “There’s a huge array of these, and the safety of some of them depends on the dose,” says Dr. Szugye. “If you’re prescribed any antidepressants, anti-anxiety medications or antipsychotic medications, I recommend working with your primary care provider, your psychiatrist or your Ob/Gyn who’s prescribing them.”
  Postpartum depression and other mood disorders are also very common. There are many safe options for nursing parents needing medical treatment that are compatible with breastfeeding.
• Dietary supplements: Dietary supplements aren’t U.S. Food and Drug Administration (FDA)-approved, so these are tricky because there isn’t a ton of research or regulation done on most supplements. “If you’re considering a dietary supplement, I always recommend talking to your healthcare provider because they can sometimes interact with other medications that you’re taking and they can cause gastrointestinal upset for the baby,” Dr. Szugye advises.

If you have any questions regarding your prescription medications, talk to your healthcare provider who can offer additional or alternative medications if something poses additional risk.