Most medications are compatible with breastfeeding because usually only a very small proportion actually reaches the breast milk. The amount of medication that reaches a baby through breast milk will depend on a number of the drugs’ properties such as half life1, molecular size, fat solubility, protein binding and what happens to it in the baby’s gut 2. If one drug isn’t recommended there is often an alternative that is safer or more compatible. Many diagnostic tests are compatible with breastfeeding as well.
This article looks at a mother’s options if her doctor asks her to stop breastfeeding in order to take a medication, discusses why stopping breastfeeding isn’t usually needed and provides resources to check drug compatibility with breastfeeding.
My doctor told me to stop breastfeeding
Sometimes a breastfeeding mother may need to take a medicine that her health professional says isn’t compatible with breastfeeding. If your doctor tells you to stop breastfeeding in order to take a specific medication, check whether they have consulted one of the resources specific to breastfeeding and medications below, or whether a more compatible drug could be prescribed. The Physicians Desk Reference (PDR) and the drug companies package insert are not reliable sources of information on drug safety when breastfeeding:
The pharmaceutical manufacturer’s resistance to using medications in breastfeeding mothers is almost always based on legal reasons, not clinical reasons. Because the PDR basically lists only the pharmaceutical’s package insert, the standard recommendation is to not take the medication while breastfeeding. The PDR is the poorest source for obtaining accurate breastfeeding information.
Explain that breastfeeding is important
Explain to your doctor how important breastfeeding is to you and your baby. As Jack Newman, a Canadian paediatrician and breastfeeding expert, says below, breastfeeding is too important to mother and baby to be stopped unnecessarily:
There are some rare situations in which a mother’s or baby’s illness means that breastfeeding cannot continue. Too often, though, health professionals recommend weaning the baby without thinking. In the vast majority of cases, stopping breastfeeding is detrimental to the baby and the mother and completely unnecessary. A health professional who is truly supportive of breastfeeding will make every effort to find ways for the mother to continue at the same time as helping her to cope with medical conditions.
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in UK. They recommend health professionals and pharmacists consult LactMed or the Specialist Pharmacy Service (see below) when prescribing to breastfeeding mothers. They state:
Health professionals should discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most cases, it should be possible to identify a suitable medication which is safe to take during breastfeeding by analysing pharmokinetic and study data. Appendix 5 of the ‘British national formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions.
Stopping breastfeeding is not usually necessary
The Womanly Art of Breastfeeding summarises why stopping breastfeeding is not usually necessary:
- Even if a mother’s blood level for a given drug is high, it’s still very dilute for her breastfeeding baby to swallow in her milk, digest, and put into his bloodstream.
- Age matters. Some drugs that might be a concern for premature infants are not a concern for full-term babies. The older the baby, the less the concern. Some mothers are mistakenly told to wean for a drug that may be given directly to babies or small children.
- When in doubt, check the baby’s blood or just watch for changes like diarrhea or fussiness.
- Temporary weaning—and pumping, and bottle-feeding an unhappy baby—is a huge physical and emotional stress during an already stressful time.
- Breastfeeding is not a faucet. Turning it off abruptly can mean turning it off permanently. Talk about risks!
- Further risk reduction: Nursing before taking the dose, waiting five “ half- lives,” finding a safer drug or treatment, even nursing part-time—all far better choices than even temporary weaning.
- Drug companies tend to recommend weaning to avoid litigation. The actual research rarely supports weaning.
Checking medications and breastfeeding
Your health professional will need to review the safety of each medication because there are a few drugs that are not compatible with breastfeeding. Reputable resources for checking medications and breastfeeding include:
#1 Hale’s Medications and Mothers’ Milk
- Book. Clinical pharmacologist, Dr. Thomas Hale is the author of this comprehensive and regularly updated book evaluating the compatibility of medications with breastfeeding Medications & Mothers’ Milk: 2019
- Website. There is also an online version of the book at Hale’s Medications and Mothers’ Milk for health professionals (requires a subscription).
- App. Available as a mobile app for android or apple devices via Infant Risk Center.
- Website. A free Drugs and Lactation Database from the US National Library of Medicine—LactMed online.
- App. There is also a free LactMed app:
Need to know more about drugs/supplements and breastfeeding? LactMed can help. Find information about maternal and infant drug levels, possible effects on lactation and on breastfed infants, and alternative drugs to consider.
#3 UK Drugs in Lactation Advisory Service (UKDILAS)
A service from the UK Medicines Information Network by the Trent and West Midlands Regional Medicines Information Centres. UKDILAS provides evidence based information for medications available in the UK for healthcare professionals and members of the public via
- A free online database see the Specialist Pharmacy Service at sps.nhs.uk
- The UKDILAS enquiry answering service by phone or email.
E-lactancia is a free online resource from APILAM 3 in Spain. It includes information on breastfeeding and phytotherapy (plants), homeopathy, cosmetic and medical procedures, contaminants, maternal and infant diseases and more. Information is available in Spanish or English.
#5 Drugs factsheets
The Breastfeeding Network (a breastfeeding charity in the UK) provide an extensive range of free online drugs factsheets covering many frequently used medications including anaesthetics, pain killers, cough and cold remedies, antihistamines (hay fever medications), vaccinations and antidepressants.
#6 Drugs in Breastmilk Information Service (UK)
For specific questions about medications or treatments message the Breastfeeding Network Drugs in Breastmilk Information Service (via Facebook) or email email@example.com
#7 Telephone helplines
- In the United States you can call the InfantRisk Center on (806) 352 2519
- In Canada contact MotherRisk on 1-877-439-2744
- In Finland contact Teratologisk Information Service 09 4717 6500 includes information on medications during pregnancy and breastfeeding in Finnish and English
- In the United Kingdom contact the UKDILAS enquiry answering service—check the link for the phone numbers and the information to have at hand before you contact them.
#8 Drugs and breastfeeding (Swedish)
Läkemedel och amning; a free online drugs and breastfeeding database for health professionals in Swedish by Stockholm County Council.
In addition to Hale’s excellent Medications & Mothers’ Milk: 2019, other helpful books that discuss the safety of individual drugs when breastfeeding include:
- Breastfeeding and Medication, Wendy Jones, 2018
- Nonprescription Drugs for the Breastfeeding Mother, Frank J Nice, 2017
If you do need to stop breastfeeding
If you do need to wean due to medical reasons have a look at How to Stop Breastfeeding so that you can stop breastfeeding without getting engorgement or mastitis.
If your doctor is not supportive of breastfeeding and asks you to stop breastfeeding to take a medication, explain how important breastfeeding is to you and your baby. Most medications are compatible with breastfeeding. If a particular drug is not compatible, alternatives with a better safety record are often available. Share the resources listed above and discuss with your physician whether an alternative treatment is possible.
**Extracts reproduced by permission from Pinter & Martin