Welcome, Lactation Consultants!

When counseling breastfeeding mothers who intend to take or are taking medications (prescription, over-the-counter, herbal, complementary), the following questions should be considered and asked. The provided answers are necessary to properly counsel mothers on the safe and effective use of medications while breastfeeding.

A stepwise approach based upon these answers can then be used to minimize infant drug exposure while breastfeeding. The steps evolve from not taking a medication to discontinuing breastfeeding. Steps can be skipped or combined as appropriate.

Following this approach, as outlined below, almost always allows the nursing infant to continue to breastfeed safely.

If what I’ve outlined doesn’t answer your questions, please feel free to reach out via email:  drnice@drniceproducts.com.

– Frank J. Nice, RPh, DPA, CPHP


Recommendations for Safe and Effective Use of Medications While Breastfeeding

I. Medication Usage: Questions for Mom

How old is the baby?

This is the basic information needed to evaluate any situation involving drug use.

Was your baby full-term or premature?

The mother may be seeking information on whether to continue breastfeeding, if and when she takes the drug. She may be questioning whether she is acting ‘correctly’ by taking the drug and continuing to nurse her baby. Also, she may have concerns about possible adverse effects to her infant.

What is your baby’s weight?

Knowing the answer to this question can help the mother determine the ability of the baby’s body to manage the amount of medication he or she could receive via breastmilk. The more the baby weighs, the more drug a breastfeeding baby can safely handle.

Is your baby currently receiving any medication?

The drug prescribed for the mother may interact with any medication the baby is taking. This is important information for the lactation consultant, pharmacist, and provider to determine the best recommendation for the situation.

What does the healthcare provider say about continued breastfeeding and taking the drug?

A provider’s philosophy and education about breastfeeding as well as knowledge of drug effects on breastfeeding, can play a large role in the provider’s opinion as to whether the mother should continue to breastfeed. The mother should have a discussion with the provider about recommendations. If the recommendations do not feel right with the parents, they could seek a second opinion.

What is the drug’s dosage schedule and how often does the baby nurse?

If a drug must be taken and breastfeeding continued, it may be possible to schedule the doses so that the peak plasma and milk levels of the drug do not coincide with breastfeeding or milk expression sessions. In most cases, it is best for the mother to breastfeed or pump just before taking a dose of a drug and/or at least two hours after taking a dose. Short-acting drugs taken on an every three to six hour schedule usually reach peak plasma and milk levels in approximately one hour.

Do you know how to hand-express milk or do you have access to a breast pump?

In some cases, breastfeeding can be stopped temporarily while a drug is administered. In these situations, milk expression must continue to prevent engorgement and to maintain the milk supply. Lactation Consultants or volunteer  La Leche League Leaders can provide you with more information.

Is this the first breastfed baby for this family?

Experienced breastfeeding mothers may be more knowledgable and determined to continue when informed they need to combine a drug with breastfeeding. If this is your first baby, find a supportive pharmacist or lactation consultant to review your options.

II. Medication Usage: Questions About Baby

How old is the baby?

Knowing this gives an indication of the infant’s ability to handle a particular drug. Also, it aids determining the infant’s feeding schedule which may influence dosage scheduling.

Was your baby full-term or premature?

The answer to this question supplies added information that helps determine the infant’s ability to detoxify drugs.

What is your baby’s weight?

This fact may be relevant to the quantity of the drug the baby may be able to tolerate without any adverse effects.

Is your baby currently receiving any medication?

Any medication that the infant is receiving can interact with medication the infant receives through breastmilk.

If the baby is receiving formula, how much does the baby receive per day?

If the baby is receiving any formula, it lessens the amount of breastmilk the baby receives. Therefore, the impact of a medication in breastmilk will be different.

Mastitis Antibiotic Algorithm

1.
Penicillinase-ResistantPenicillins

First Choice: Dicloxacillin. Cloxacillin, Methicillin, Nafcillin

2.
Macrolides (Penicillin Allergies)

First Choice: Azithromycin. Clarithromycin

3.
Aminoglycosides

Clindamycin, Vancomycin (IV) if incision and drainage are necessary

4.
Sulfamethoxazole/Trimethoprim Oral

Use if incision and drainage are necessary

5.
Cephalosporins
6.
Linezolid

 High rate of thromboplastinemia

7.
Kanamycin
8.
Chloramphenicol

DO NOT breastfeed if this drug is necessary

Reference Materials

Medications & Breastfeeding

Recreational Drugs & Effects on Breastfeeding

Oxytocin Nasal Spray

Common Herbs & Foods Used as Galactogogues

Selection & Use of Galactogogues

Dr. Nice’s Books for Purchase

All proceeds from the sales of Dr. Nice’s books supports the work of the non-profit humanitarian relief organization, Health and Education for Haiti. Learn more at hehonline.org.

NonPrescription Drugs for the Breastfeeding mother
NonPrescription Drugs for the Breastfeeding Mother by Frank J. Nice, RPh, DPA, CPHP

In it’s second edition, this book provides easy-to-follow guidelines for making safe decisions for your clients about the use of OTC medications, herbals and dietary supplements.

Recreational drugs and drugs used to treat addicted mothers
Recreational Drugs and Drugs Used to Treat Addicted Mothers by Frank J. Nice, RPh, DPA, CPHP

Provides a rational framework that can successfully guide clinical decision making on the impact of certain drugs on pregnancy and breastfeeding.

The Galactagogue
recipe book
The Galactagogue Recipe Book by Frank J. Nice, RPh, DPA, CPHP & Myung H. Nice

Over 200 recipes featuring major and minor galactagogues-certain foods and herbs that likely increase prolactin or oxytocin to initiate the breastmilk letdown reflex, helping to increase production.

Questions? We’d love to hear from you.

If you have breastfeeding or lactation questions for Dr. Nice or you’re interested in scheduling a consultation or lecture, please reach out via email.