Drug Use While Breast-Feeding

Breast-feeding is recommended by the American Academy of Pediatrics (AAP) for at least the first 6 months of a baby?s life. Breast milk contains the ideal amounts of carbohydrate, fat, and protein for a baby?s nutrition. It provides digestive enzymes, vitamins, minerals, and hormones that benefit the baby. It also allows antibodies to pass from the mother to the baby, which protect the child from some illnesses. In addition, breast-feeding provides a special bonding experience between mother and child.

The birth of a child and breast-feeding can be exciting but also frightening and confusing for a new mother. Many substances, both healthy and unhealthy, can be transferred to the baby through the breast milk, including medications. The new mom may wonder: Will this medicine hurt my baby? Will the time that I take the medicine affect how much is in the breast milk? What do I do if I have to take a medicine that is dangerous to my baby, but I want to continue to breast-feed?

The AAP gives the following tips:

• With your physician or pharmacist, determine whether the drug is necessary.
• Choose medications with the highest safety record.
• Consider having blood levels of the drug tested.
• Minimize drug exposure by taking the medicine right after breast-feeding or just before the baby is due for a long sleep period.

Many medications are safe to use while breast-feeding. The AAP strongly recommends that breast-feeding mothers avoid certain other drugs or use them only if necessary. These drugs include aspirin, blood pressure drugs, and anti-seizure medicines. The use of these medications should be discussed with the mother?s obstetrician as well as the pediatrician. Other medications that should not be used include chemotherapy agents and drugs that cause immune suppression in the infant. It is unknown whether these medicines affect growth and/or cancer risk in the child.

Illegal drugs never should be used by anyone, especially a nursing mother. Infants whose mom used amphetamines, cocaine, heroin, marijuana, or hallucinogens while breast-feeding can suffer harm such as irritability, intoxication, tremors, seizures, vomiting, and poor feeding and sleeping habits.

The nursing mother should temporarily stop breast-feeding when taking radioactive compounds before certain diagnostic tests. The mother can pump breast milk and freeze it for use by the infant while the radioactive compound is in her system. Breast-milk samples can be screened by radiology departments before the mom resumes nursing.

The effects on the infant are not known for some other drugs. These drugs include many anxiety, antidepressant, and antipsychotic drugs, which cross over into breast milk.

Smoking or using any nicotine-containing products while breast-feeding should be avoided. The nicotine causes decreased milk production in the mother and thus poor weight gain in the infant. The harmful effects of secondhand smoke, including sudden infant death syndrome, also should be considered.

Alcohol used by the mom while breast-feeding crosses over to the infant. Symptoms of alcohol presence in the baby include sedation and poor growth. Alcohol use also decreases the milk-ejection reflex, making it more difficult for the mother to breast-feed.

Caffeine passes into breast milk as well, causing the baby to have a poor sleeping pattern, to become irritable, and perhaps to have poor feedings. Moms should drink no more than 2 or 3 cups of caffeinated beverages per day or drink decaffeinated products.

It is always best to let your doctor, pediatrician, and pharmacist know that you are breast-feeding or planning to do so. Talk to them before taking any medications, including over-the-counter products.

General recommendations for drug use while breast-feeding include the following:

• Talk with a health care provider before taking ANY medication.
• Take medicine immediately before or after breast-feeding to minimize the passage into breast milk.
• Use short-acting medications if possible.
• Discard breast milk that is expelled during acute medication use.
• Take a daily multivitamin.
• Consume at least 1200 to 1500 mg of calcium daily while breast-feeding.

Dr. Sasser is an assistant professor at Campbell University School of Pharmacy and a clinical pharmacist at Duke Community and Family Medicine, Durham, NC.