Medication and drugs while breastfeeding

Can I breastfeed while I’m on medication?

Most products that go into your body end up in your breast milk. You should always consult with your health care provider before taking any medication, drug, or herbal remedy. You will have to consider the benefits of taking the drug versus the risks to the baby. In general, most medications that are applied to the skin, inhaled (for example, asthma treatments), or applied to the eyes or nose are safe for breastfeeding women. Most vaccines are safe, as are most medications that are commonly prescribed to infants. Other medications may pose a higher risk and are usually not used while breastfeeding. If you required a drug in pregnancy to control a medical problem (e.g., diabetes, high blood pressure), you will likely still be taking that medication in the postpartum period. You can talk with your doctor about any effects your medication(s) might have on breastfeeding and the need to alter the dosage. Other drugs that are a problem in breastfeeding include anti-cancer drugs, immune suppressants, ergot alkaloids, radioactive medications and anticonvulsants. The safety of medications also depend on the age of the infant – babies older than six months are less vulnerable, where newborns and premature infants are most at risk.

Will taking medications affect my milk production?

Some medications can decrease milk production. These should not be used by breastfeeding mothers, especially when the baby is very young:

• Antihistamines
• Sedatives
• Some decongestants
• Some weight loss medications
• Diuretics
• High doses of vitamin B6
• Nicotine
• Ergot alkaloids

What about alcohol, caffeine, smoking, and street drugs?

• Alcohol. Alcohol freely distributes into milk and will be ingested by nursing infants. Low-level, occasional alcohol consumption is not likely to pose a problem to the infant but heavy alcohol consumption or binge drinking is to be avoided. Ideally, nursing should be withheld temporarily after alcohol consumption; at least two hours per drink to avoid unnecessary infant exposure. Side effects reported in infants include sedation and impairment of motor skills.
• Caffeine. Consumption of caffeine in moderate amounts (no more than two cups of coffee per day) is not likely to be harmful to your nursing infant.
• Cigarette smoking. Smoking is not recommended for nursing mothers. Nicotine and its major by-products are detectable in milk. Smoking while breastfeeding has been associated with infantile colic and lowered maternal prolactin levels, which lead to earlier weaning. Additionally, caution should be used to avoid infant exposure to second-hand smoke.
• Cannabis. There is little information available about cannabis use while breastfeeding. THC, the main active ingredient in cannabis that makes it intoxicating, can be found in breastmilk. Its concentration, or strength, in breastmilk depends on whether the mother is smoking, inhaling, or eating cannabis, and how often. While research still doesn’t give us all the answers about the effects of cannabis, for now, the only safe amount of cannabis to use while breastfeeding is zero.
• Opioids. Breastfeeding mothers using prescription opioids or in treatment for opioid use, should be able to safely breastfeed, but there may be exceptions for medical reasons. To be cautious, women using opioids should speak with their health care provider about their breastfeeding options.
• Street drugs. Street drugs can be very potent, so even very small amounts can be very dangerous for an infant. It is suggested that breastfeeding be temporarily delayed immediately after maternal use of these products and caution should be used to make sure your baby doesn’t breathe smoke fumes.