Most medicines are safe during breastfeeding

A new clinical report from the American Academy of Pediatrics (AAP) Committee on Drugs says that many medicines are safe to use for breastfeeding mothers, but it cautions that the risk of exposure for babies to any drug through breast milk must be evaluated for both the importance of the medication to the mother and the benefits of breastfeeding for the infant.

The report says that although many mothers are advised to discontinue breastfeeding or to avoid taking certain medications for fear of exposing their infants to adverse effects through breast milk, the caution may be unwarranted because only a few drugs are contraindicated for breastfeeding mothers. In addition, pediatricians may be overly concerned about medications for which information on the degree of excretion of certain drugs into breast milk may not be readily available.

Whether a drug is used on a short-term or long-term basis-to treat acute or chronic illnesses-the potential effects on milk production, the amount of the drug that passes into breast milk, and the infant’s age and overall health are all factors that influence the decision to treat the mother with specific medications.

The research committee looked at antidepressants, which could build up in babies’ systems because they break down slowly; narcotics including codeine and morphine, which should be used with caution at the lowest dose for the shortest time; and smoking cessation aids, which generally are safe during breastfeeding, except for cessation drugs such as varenicline that should be avoided.

The report advises physicians to consult the National Institutes of Health drugs and lactation database (LactMed) to determine which drugs are safe for lactating women and the possible adverse effects of drugs, supplements, and other chemicals on breastfeeding infants. It recommends that elective imaging procedures be delayed until a woman is no longer breastfeeding to avoid possible radioactivity in breast milk and exposure of the infant through close maternal contact. The report also says that maternal immunizations during lactation do not affect their breastfeeding infants.

When LactMed or pharmaceutical labeling does not address physicians’ concerns, the AAP committee recommends consultation with specialists.

Women who breastfeed are advised to tell their pediatricians about any over-the-counter drugs or herbal supplements, as well as prescription medications, that they may be taking.

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