Breastfeeding and medications
Balancing maternal medication needs with infant safety during breastfeeding.
Breastfeeding and medications addresses the use of medications by nursing mothers, balancing maternal health with infant safety. Most drugs transfer into breast milk, usually in small amounts, and many pose minimal risk to the infant. Informed decision-making and professional guidance are necessary.
Quick Facts
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- National Institutes of Health (NIH)
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Evaluating the potential for adverse effects
The safety of a medication during breastfeeding is assessed by several factors: the amount of drug present in breastmilk; the infant's age, maturity, and weight; the proportion of breastmilk in the infant's diet; the general health of both mother and infant; the nature of the mother's illness; existing literature on the drug; the duration of therapy; whether a short-acting form is available; the route of administration; and whether the drug interferes with lactation.
Lactation risk categories
Drugs are classified into five lactation risk categories. Category L1: a drug taken by many breastfeeding mothers with no observed increase in adverse effects, and controlled studies show no risk; or the product is not orally bioavailable. Category L2: studied in a limited number of breastfeeding women without increased adverse effects, and the risk is remote. Category L3: no controlled studies exist, but risk is possible; or controlled studies show only minimal non-threatening effects; new drugs with no published data are automatically placed here. Category L4: positive evidence of risk to the infant or milk production, but use may be acceptable in life-threatening situations or serious disease when safer alternatives are unavailable. Category L5: significant documented risk to the infant based on human experience, or high risk of causing significant damage; the risk outweighs any benefit, and the drug is contraindicated in breastfeeding women.
Over the counter medications
Over the counter medications do not require a prescription in the US, though some may be available without prescription elsewhere. Taking oral medications after breastfeeding rather than before allows some drug to be eliminated between nursings. In most women without kidney disease, nonsteroidal anti-inflammatory drugs and paracetamol (acetaminophen) are used safely. Aspirin can cause rashes and bleeding in infants. Antihistamines should be limited; they may cause crying, sleep problems, fussiness, or excessive sleepiness in babies and can decrease milk supply. Infants should be observed for side effects such as difficulty breathing or rash. Other young children in the home should be kept away from these medications. Hair dye or permanent wave solutions do not pass into breastmilk. Older antihistamines may cause drowsiness in the infant, potentially leading to missed feedings.
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