Breastfeeding and medication

Breastfeeding and medication

One common area of concern for breastfeeding mothers is medication safety. It can be very difficult to accurately estimate what concentration of a drug finds its way via a mother’s blood stream through to her breast milk. But it is best to always err on the side of caution and seek expert pharmaceutical advice before taking any drug. Be suspicious until you have had professional guidance that what you plan to take is safe.

Although a particular medication may be fine for you, even small concentrations of certain drugs can pose a risk to a small baby or child. Their metabolism may not be mature enough to cope and the consequences can be dangerous.

Factors which Influence Drug Concentration

• The drug itself. Some drugs are considered safe for breastfeeding mothers to take. In the correct dosage and when taken as directed, they do not pose a risk.
• The dose of a drug. Balancing therapeutic benefit for the mother whilst reducing the risk of harm to the baby is important.
• The concentration of fat in the breastmilk. The fat component of milk is commonly where a drug is stored and transported.
• When the drug has been taken in relation to breastfeeding. Drug concentrations vary depending on how much time has passed since they have been ingested. Generally there is a 1-2 hour time frame between ingesting a drug and it being detected in the breast milk.
• Other drugs which are being taken at the same time. Some drugs interact with others and can either increase or reduce the effectiveness of each other.
• When a meal was last eaten. Taking medication on an empty stomach changes the pattern of its absorption compared to when it is taken with a meal. Some foods are contra-indicated with particular medications and there is a risk of medical complications.
• If the mother has had any alcohol to drink or taken any dangerous substances.

General Recommendations

• Breastfeeding is so beneficial to a mother and her baby that unless a drug is absolutely contra-indicated, stopping breastfeeding should not be necessary.
• Lactating and breastfeeding mothers should avoid taking any medication unless it is genuinely warranted.
• Mothers need to advise their prescribing doctor and/or pharmacist that they are breastfeeding. Ask specifically “Is this drug safe for me to take and will it harm my baby?” There are many evidenced based reference points which they can use to check. You may need to wait while they do a follow up.
• If one medication is contra-indicated in breastfeeding, there are usually alternatives which may be considered.
• Without medication, there is a risk that some medical conditions may worsen. Following the absolute philosophy of not taking anything whilst breastfeeding may not be realistic in all situations.
• Generally, babies who have been exposed to a particular medication whilst in the uterus have already received a higher concentration than what they will receive via breast milk.

Drug Side Effects in Breastfed Babies

These can vary, depending on the age and maturity of the baby and their size. Some of the more common side effects include:

• Drowsiness and sleeping more than usual.
• Fussiness and disinterest in breastfeeding.
• A rash, diarrhoea, vomiting and unsettledness.
• Gut discomfort and disturbance.
• Some drugs change the odour and taste of breast milk to the point where the baby may refuse to feed.

Occasionally it is necessary for lactating mothers to express and discard their breast milk for a short period of time. This can happen when a breastfeeding mother has no other choice but to take a medication which is contra-indicated. Regular expression and breast emptying will help to maintain breast milk supply so that breastfeeds can resume as soon as possible.

Not All Drugs are the Same

It’s important to remember that not all medications are limited to those which can be bought at the pharmacy or supermarket. Herbal preparations, vitamin and mineral supplements and “natural remedies” need to be assessed as safe and suitable during periods of lactation. Combination products can be particularly risky as it can be difficult to identify exact concentrations of individual compounds.

Other substances can contain potentially harmful chemicals which pose a risk to a breastfed baby. These include:
1. Alcohol
2. Cigarettes
3. Marijuana and other illicit drugs
4. Caffeine

General Recommendations

1. Alcohol is best avoided by breastfeeding mothers. The concentration of alcohol in a mother’s breast milk closely matches her
blood alcohol level. This is also dependent on a mother’s physical size, the volume she has had to drink and the type of alcohol ingested. The current recommendation is that for every standard drink, the baby should not be offered a breastfeed for 2-3 hours. Choose low alcohol alternatives, limit the number of alcoholic drinks you plan to have and alternate each alcoholic drink with mineral or soda water.
2. Cigarettes contain a toxic combination of chemicals which pass readily into breast milk. Babies of mothers who smoke cigarettes are more at risk of SIDS, upper respiratory tract infections, gastro-intestinal illnesses and asthma. Cigarettes also lower the volume of breast milk produced.
3. Depending on the type of illicit drug used, babies are impacted via breast milk. Side effects can be sleepiness and poor feeding, and dependency for both the mother and her baby if the drug use continues.
4. Caffeine is present in tea, coffee, cola and some sweets. The general recommendation for breastfeeding mothers is to not exceed more than 3 cups of coffee per day. Excess caffeine can reduce the concentration of iron in breast milk as well.

Where to Get Advice

• Your General Practitioner. Most have on-line access to up to date medication and prescribing information such as MIMS.
• A Pharmacist.
• Your local public hospital’s pharmacy department. Most Australian states have a Medication Helpline service with a free call number. Check your local telephone directory for access information.
• “National Prescribing Service”: http://www.nps.org.au/consumers/ask_an_expert/contact_a_health_professional/medicines_line .
• Australian Breastfeeding Association
• The Pharmacy Guild of Australia
• The Royal Women’s Hospital Melbourne