Do all medications pass into breast milk?

Nearly any medicine classified in the blood will pass into breast milk at some level. The majority of drugs do so at low levels and do not pose an actual hazard to most babies. There are some exceptions, however. Some medications exist at high levels in breast milk. Consequently, all drugs need to be taken individually.

Does the health and age of infants control how they can be influenced by medication in breast milk?

Yes. Premature infants, new-borns, and medically unstable or kidney-impaired babies are the most at risk from exposure to medication in breast milk.

But drugs administered within the two days following delivery pass on at very low levels to your baby. The reason is that you do not produce much breast milk during this period.

Risk is lowest for healthy infants 6 months of age and older. At this age, infants' bodies metabolize drugs effectively.

Do I need to discontinue breastfeeding while taking medication?

Most medications are safe to take while breastfeeding. The benefit of continuing a medication for a chronic condition may outweigh any potential risks.

Nevertheless, some medications are not safe to use while breastfeeding. If you're using a medication that may be dangerous for your baby, your doctor may suggest an alternative medication. Or they may suggest breastfeeding after the level of the medication is low in your breast milk.

At times, your doctor may advise you to discontinue breastfeeding permanently or temporarily, depending on how long you need to use the drug. If you are aware beforehand, you may express milk as well as breastfeed and save the expressed milk. Then, utilize the saved breast milk after you have started administering the drug.

If you only need to wean off of breastfeeding temporarily, pump with a double electric breast pump to maintain your milk supply until you can resume breastfeeding. Discard the milk that you pump while you are on the medication.

If you're uncertain whether a drug is safe during breastfeeding, pump, label, and store expressed breast milk until you consult with your doctor. If you must discontinue breastfeeding permanently — this is rare — consult with your doctor about weaning and in selecting an infant formula.

What medications are safe while breastfeeding?

With the advice of your doctor, use this list of medications that have been found safe to use during breastfeeding. Remember, this is not an exhaustive list of safe medicines.

Painkillers

Acetaminophen (Tylenol, others)
Ibuprofen (Advil, Motrin IB, others)
Naproxen sodium (Aleve, Anaprox DS, others) — for brief use only

Antimicrobial drugs

Fluconazole (Diflucan)
Miconazole (Monistat 3, Monistat 7, others) — use the minimum amount
Clotrimazole (Mycelex, Lotrimin AF) — use the minimum amount
Penicillins, including amoxicillin and ampicillin
Cephalosporins, including cephalexin

Antihistamines

Loratadine (Claritin, Alavert, others)
Fexofenadine (Allegra Allergy)

Decongestants

Medications with pseudoephedrine (Sudafed, Zyrtec D) — use cautiously since pseudoephedrine can lower milk supply

Birth control

Progestin-only contraceptives, also called the minipill
Combination contraceptives with estrogen and progestin — talk to your provider about this choice

Researchers don't have a definitive answer regarding whether combining contraceptives with estrogen and progestin impacts milk production. Consult your doctor before taking this form of birth control if you are breastfeeding.

Medications for the gastrointestinal system

Famotidine (Pepcid, Zantac 360)
Antidepressants
Paroxetine (Paxil, Brisdelle, others)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Medications for constipation
Docusate (Colace, Phillips' Stool Softener, others)

Is my doctor's approval required in advance?

If you are breastfeeding and are going to have to take medication, consult your doctor. Do not take drugs you don't really need, like herbal medicines, megadose vitamins and strange supplements.

And ask about timing. Taking a drug right after breastfeeding may decrease your baby's exposure, for instance. However, various drugs have different timing for peaking in breast milk.

What if my baby reacts to it?

Monitor your baby for changes in sleep and eating habits, fussiness, or rash when you are on medication. If you observe a change in your baby's behavior, call your child's doctor.