Is it Safe to Use Medicine During Breastfeeding?

OTC; used for pain/fever/headache; amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.¹

This drug is considered compatible with breastfeeding by the American Academy of Pediatrics and WHO.^2,3

OTC; used for stomach upset, heartburn (dyspepsia)

The World Health Organization (WHO) and LactRx consider compatible with breastfeeding; however, continue to monitor baby for side effects.^1,2,3

Prescription/over-the-counter; Bayer Aspirin, Bufferin, Ecotrin, others.

In general, aspirin use is best avoided during breastfeeding. Acetaminophen may be safer for pain relief.

Expert opinion indicates that low-dose (75 to 325 mg daily) aspirin may be used as a blood thinning agent for use in breastfeeding women who require it. Monitor the infant for bruising and bleeding.¹

Avoid high-dose, long-term use of aspirin, if possible. A case of metabolic acidosis has been reported.^2,3

Found in coffee (80-150 mg per 6 ounce cup), tea, soft drinks (cola), energy drinks, yerba mate, chocolate, guarana, some OTC medications.

For example, one Starbucks Grande (16 oz) contains ~300 mg caffeine.

A stimulant that DOES pass into breast milk.

Excess caffeine in the mother can lead to stimulation in infants. Watch for irritability in your newborn.

Avoid concentrated energy drinks, pure caffeine tablets.

A maximum caffeine consumption of 300 mg to 500 mg per day is suggested in the U.S., in Europe 200 mg is the recommended likely safe limit.¹

Caffeine levels from breast milk may be higher in preterm infants; lower caffeine consumption may be advisable.¹ 

Coffee intake >450 mL per day (about 2 measured cups) may lead to a decrease iron in breastmilk and cause mild iron deficiency in some infants.¹

Most cephalosporins are considered compatible with breastfeeding. Check each drug individually.

Rx; broad-spectrum antibiotics for infections.

Limited data suggests that many cephalosporins given to the mother produce low levels in milk that are usually not expected to cause side effects in breastfed infants.⁵

Clotrimazole (troches or topical)

Rx/OTC; used to treat yeast and fungal infections.

Poor oral bioavailability, unlikely to adversely affect the breastfed infant, including topical application to the nipples.¹

Various brand and generic options available.

Used for birth control. Generic options may be available.

Nonhormonal methods of birth control may be preferred during breastfeeding in some women (this includes the copper IUD, condoms, diaphragm and cervical cap).

You can use the shot, implant, some types of IUDs, and progestin-only birth control pills (“mini-pills”) right after giving birth.⁶

Progestin-only contraceptives are considered the hormonal contraceptives of choice during lactation, especially during the first 4 weeks postpartum.⁶ Norethindrone has not been shown to affect milk supply, milk composition or growth and development of the infant based on fair quality evidence.¹

Research has found that combined birth control pills (that contain estrogen + progestin) do not affect milk production if started 4 weeks after delivery.⁶

Combination birth control pills started within 3 to 6 weeks after delivery may elevate risk for blood clots, based on patient risk level.^1,3,6

Examples: prednisone, prednisolone

Rx; used to treat inflammation, pain of joints and many other conditions.

As reported by the WHO, corticosteroids at normal doses during breastfeeding can be used, with monitoring of the baby.³

LactRx reports that amounts of corticosteroids are very low in breastmilk and no adverse effects have been reported in breastfed infants with any corticosteroid.¹

High doses might cause temporary loss of milk supply.¹

OTC; Used to treat stuffy noses.

Limited systemic absorption.

Recommended over oral decongestants (such as pseudoephedrine or phenylephrine), which may inhibit milk production.¹

Rx; used for heart failure, other heart problems.

If given intravenously, avoid breastfeeding for 2 hours after dose.¹

Because of the low levels of digoxin in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.¹

Rx; macrolide used for skin and respiratory infections.

Low levels in breast milk; used safely in infants.

Monitor infant for diarrhea, candidiasis (thrush, diaper rash), irritability.¹

OTC; non-drowsy antihistamine for allergies and hay fever.

Lack of sedation and low milk levels; maternal use of fexofenadine would not be expected to cause any adverse effects in breastfed infants.¹

Combined use with decongestants (i.e., phenylephrine, pseudoephedrine) may lower breast milk production.

Rx; May be used to treat yeast infections, Candida mastitis.

Acceptable in nursing mothers because amounts in breastmilk are less than the neonatal dose.^1,2

Rx; used to keep blood from clotting.

Not expected to be appreciably excreted into breastmilk or absorbed by the infant due to high molecular weights. No special precautions are required.¹

Rx/OTC: used for muscle and joint pain relief, to lower inflammation, fever, headache relief.

Due to low levels in breastmilk, short action (half-life), and safe use in infants in doses higher than those found in breastmilk, ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers.^1,3

Rx; used for asthma.

Limited published data; data from terbutaline indicate that very little is expected to be excreted into breastmilk.

Experts agree use of inhaled bronchodilators acceptable due to low bioavailability and maternal serum levels after use.¹

Mothers with diabetes using insulin may nurse their infants.

Careful observation of increased maternal caloric needs, insulin needs and maternal blood glucose levels are needed.

Rx; for diabetes / elevated blood sugar.

Basal insulin requirements may drop up to 21% on average during lactation, but is widely variable.¹

Endogenous insulin is a normal component of breast milk.

Insulin, including newer biosynthetic insulins (aspart, detemir, glargine, glulisine, lispro) is a protein that is inactivated and destroyed in the digestive tract of the infant if taken by mouth.^2,7

OTC; used to treat constipation.

Few data are available, but psyllium is not absorbed from the gastrointestinal tract, so it cannot enter the breastmilk. It is acceptable to use during breastfeeding.^1,2

Docusate is minimally absorbed and is unlikely to be found in breastmilk. Laxatives that are completely unabsorbed may be preferred over docusate.^1,2

Polyethylene glycol is very poorly absorbed from the gastrointestinal tract, so it cannot enter the breastmilk in important amounts. No special precautions are required.^1,2

Rx; a local anesthetic.

Lidocaine is poorly absorbed by newborns. Lidocaine is not expected to cause side effects in breastfed infants.^1,2

OTC; non-drowsy antihistamine for allergies and hay fever.

Lack of sedation and low milk levels. Not expected to cause adverse effects in nursing infants. Some experts recommend to use at the lowest dose as a preferred choice during lacation.²

Loratadine might have a negative effect on lactation, especially in combination with a decongestant like pseudoephedrine or phenylephrine.^1,2

Rx; used for prevention and control of seizures in pre-eclampsia and eclampsia.

Postpartum IV use longer than 6 hours may delay onset of lactation.¹

See Summary of Use during Lactation²

Rx; used to treat high blood pressure; no special precautions needed.

Because of the low levels of methyldopa in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.^1,2

Rx; a beta-blocker used to treat high blood pressure.

Small amounts ingested by infant; no special precautions are required.

Studies on the use of metoprolol during breastfeeding have found no adverse reactions (side effects) in breastfed infants.

However, monitor for slow heart rate and inactivity (listlessness) due to low blood sugar levels.^1,2

OTC; used to treat yeast infections.

Poor oral bioavailability and poor absorption from skin or vagina. Unlikely to affect the breastfed infant, including topical application to the nipples, but rarely prescribed.^1,2

Rx; calcium channel blocker used to treat high blood pressure and angina (chest pain); also used to treat painful nipple vasospasm.¹

Studies on the use of nifedipine during breastfeeding have found no adverse reactions in breastfed infants. Amount ingested by infant are small.^1,2

Rx; used to treat bacterial infections.

Occasionally, rash and disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, have been reported with penicillins, but these effects have not been adequately evaluated. Low levels occur in milk.

Amoxicillin, penicillin G, penicillin V are acceptable in nursing mothers.^1,2

Rx; a beta blocker used to treat heart problems, high blood pressure, and infantile hemangiomas.

Low levels in breastmilk; studies in infants have not found side effects due to propranolol. Not expected to cause side effects in breastfed infants. No special precautions are needed.^1,2

Elixophyllin, Theo-24, others

Rx; used to treat asthma and bronchitis.

Monitor infant for irritability, stimulation, and trouble sleeping in newborn and especially preterm infants.

Keep maternal serum concentrations in the lower part of the therapeutic range and monitor the infant for signs of theophylline side effects. Consider infant serum monitoring if needed.

Delay nursing for 2 hours (after IV dose) or 4 hours (after oral immediate-release dose) if possible (to delay dose received by breastfed infnat). Delayed nursing may have no effect if taking long-acting (sustained-release) forms.^1,2

Rx; topical cream used for acne; use only water-miscible cream or gel products.

Rx; replaces the thyroid hormone normally produced by your body to help regulate your energy and metabolism.

Levothyroxine is excreted into milk, but as T4 it is a normal component of breast milk. Use is considered acceptable. The American Thyroid Association recommends hypothyroidism in lactating women should be treated with levothyroxine.^1,2

Breastfed infants should be vaccinated according to routine established schedules from the ACIP and as recommended by your healthcare provider.

According to the ACIP’s General Best Practice Guidelines for Immunization in Special Situations, except for smallpox and yellow fever vaccines, neither inactivated nor live-virus vaccines administered to a lactating woman affect the safety of breastfeeding for women or their infants.

When nursing mothers cannot avoid or postpone travel to areas endemic for yellow fever in which risk for acquisition is high, these women should be vaccinated.⁸

COVID-19 vaccines: If you are breastfeeding, you can receive a COVID vaccine. According to the CDC, vaccines are safe and effective at preventing COVID-19 in mothers who are breastfeeding and are safe for their babies.

Studies have shown that breastfeeding mothers who have received mRNA COVID-19 vaccines have antibodies in their breast milk, which could help protect their babies.⁹

Rx; oral antibiotic often used to fight bacterial infections in the bowels. 

Limited information indicates that oral vancomycin produces low levels in milk. 

Because vancomycin is poorly absorbed when taken orally, it is unlikely to enter the bloodstream of the infant or cause side effects. No special precautions are required. ^1,2

Rx; calcium channel blocker used for high blood pressure, angina (chest pain).

Data are limited but suggest that doses of verapamil up to 360 mg daily given to the mother produce low levels in milk and newborns.

Verapamil would not be expected to cause side effects in breastfed infants, especially in infants over 2 months.^1,2

Rx; an anticoagulant (blood thinner) used to treat or prevent blood clots. Helps to prevent heart attacks, stroke and other serious conditions.

Very low levels of warfarin occur in milk with warfarin doses in the mother up to at least 12 mg per day.

Amounts consumed by the infant are small. No side effects in breastfed infants have been reported from maternal warfarin use during breastfeeding, even with a maternal dose of 25 mg daily for 7 days.

No special precautions are suggested.^1,2