Medications and breastfeeding: which ones are safe to take?

Why certain medications should not be taken if you are breastfeeding? 

Some medications are not recommended for breastfeeding women because of the risks they present to the baby. These risks fall into three main categories:

1/ Drugs that are toxic for baby 

Some medicines can pass into breast milk in significant quantities and harm the baby. For example, antibiotics can cause digestive problems or affect the child's dental development. Treatments for mental disorders can cause drowsiness or lethargy in the baby.

2/ Drugs that affect lactation 

Certain treatments can reduce milk production. For example, bromocriptine, a dopamine agonist for Parkinson's disease (Parlodel®), and cabergoline (Dostinex®), prescribed for the symptomatic treatment of hyperprolactinaemia, slow down the release of prolactin, a hormone essential for milk production.

3/ Drugs that are difficult to eliminate due to immaturity of the newborn's systems

As the liver and kidneys of newborns are still developing, some drugs are eliminated more slowly, which can lead to their accumulation and increase the risk of toxic effects. This is the case with non-steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac, Celebrex® or Nurofen®.

Before taking any medication, breast-feeding mothers must see a health professional to assess the benefits and risks for their child.

What medications can you take while breastfeeding? 

Many drugs are however considered safe for both the breastfeeding mother and her baby.
Here is a list of the most commonly used ones:

Pain killers and anti-fever medication 

Paracetamol and ibuprofen are widely recommended for relieving pain and fever in breastfeeding mothers. Their passage into breast milk is minimal, making them compatible with breastfeeding. 

Antibiotics 

Antibiotics such as amoxicillin, penicillins and cephalosporins, a class of β-lactam antibiotics (Distaclor®, Suprax®), are generally considered safe for breastfeeding mothers and their newborns. They are commonly prescribed to treat a variety of bacterial infections.

Antihistamins 

To treat allergies, non-sedating antihistamines such as loratadine and cetirizine are usually prescribed for breastfeeding women, as they present a low risk of drowsiness for infants.

Some drugs for certain chronic conditions 

Some treatments for conditions such as high blood pressure, diabetes or thyroid problems are compatible with breastfeeding. However, a medical assessment with your GP is necessary for each individual case.

What medications cannot or should not be taken while breastfeeding? 

For breastfeeding women, certain medicines are not recommended or are completely prohibited because of the risks they may have for the baby.
Here is a list of the main categories of drugs to be avoided:

Opioids

Codeine and tramadol are generally not recommended for breastfeeding women due to the risk of respiratory depression in newborns. These drugs should only be used on medical advice, for a very short period (2 to 3 days) and at the lowest possible dosage.

Antidepressants and anti-anxiety medication

Certain selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, and benzodiazepines such as diazepam, can cause drowsiness, lethargy and slowed weight gain in newborns. It is therefore recommended that these medications be avoided or used with extreme caution under medical supervision.

Oral decongestants 

Medicines containing pseudoephedrine (Actifed®, Care®), used to relieve nasal congestion, can significantly reduce milk production by lowering prolactin levels. Their use is therefore not recommended during breastfeeding.

Over-the-counter medicine 

Cough syrups, anti-inflammatory drugs or natural remedies can be harmful to babies.

What can you do if your medication is incompatible with breastfeeding? 

When a drug is incompatible with breastfeeding but is still essential for the mother's health, there are several solutions that allow the treatment to be continued without major risks for the baby.

Many drugs have safe equivalents for breastfeeding. For example, in the event of pain, paracetamol is often preferred to other, more powerful painkillers. A doctor or pharmacist can also advise you on the best option to replace a potentially harmful drug.

If no alternative is available, it may be advisable to take the medicine immediately after feeding the baby. This method limits the presence of the drug in breast milk at the time of the next feed, thereby reducing the newborn's exposure.

In cases where no adjustment is possible, a temporary break in breastfeeding may be considered.

In addition, before starting treatment, it is recommended to express and store breast milk to ensure that baby is fed during mother's treatment. A final word of advice: to avoid a drop in lactation, mothers should continue to stimulate lactation by expressing milk regularly.

Conclusion 

Taking medication while breastfeeding is possible, provided you are well informed. Many treatments are harmless, and if in doubt, you should ask a healthcare professionals for any alternatives.

If you are being treated for a chronic illness or if you become ill while breastfeeding, talk to a health professional before taking any treatment.

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