When You Need to Take Medication

on January 14, 2014 in Breastfeeding, Medications and Breastfeeding

Like most every nursing mother, you may have a headache or a cold, or you may need to fill a prescription given to you by your doctor.  Most breastfeeding mothers wonder if it will be safe to continue nursing while taking a certain drug or if it could affect your milk supply.


While you probably have avoided most all medications while pregnant, many moms feel that the same is true when breastfeeding.  This is not necessarily the case.  During pregnancy, medications generally pass through the placenta directly to the fetus, making many medications inadvisable.  But the same is not necessarily the case when nursing.  While most medications pass through the breast to some degree, few are harmful to a nursing child.


Studies have shown that nearly 90% of medications are transferred to a nursing baby in amounts of 10 percent or less of the mother’s dose. And half of these medications reach the nursing baby in amounts less than 1% of the dose taken by the mother.  Only about 3% of medications reach the breastfed baby in the amounts taken by the mother.


There are other considerations as well.  Premature infants may not be able to handle medications less well that a term baby. Babies more than two months of age or older, typically have fewer problems handling a drug than a newborn infant.


Medications that have been used for years have a clearer history of safety than newer drugs. Taking a drug that has been used for many years will have more reassuring information than something else that has just come out on the market.


All too often, doctors who are less familiar with the safety of drugs in breast milk, turn to “The Physician’s Desk Reference.”  This guide lists every medication and is simply a compilation of package inserts written by the drug companies.  The drug companies, who want to avoid legal liability, typically warn that their medication should not be used during pregnancy and breastfeeding.  So if your doctor or dentist, refers to the “PDR”, you may not be getting the information you need to make a good decision on the safety of any drug.  According to a recent study, Pharmacists in drug stores may not have current information on the safety of medications as they also rely on drug insert information from the drug companies. I know of needless cases of early weaning or “pumping and dumping” when a mother has gotten poor advise or mothers choosing not to take a medication when needed.  I recently got a call from an upset mother who was told by an Emergency Room M.D. that she needed to “pump and dump” after having a procedure done.  In fact, the procedure that she had was perfectly safe for nursing mothers and she was very relieved to not have to stop breastfeeding.


Taking something over-the-counter is not necessarily safe for your baby or your milk supply and it can be harder to determine a products’ safety especially when there are multiple ingredients. For this reason, single ingredient drugs are generally a better choice.  With that being said, taking pseudoephedrine for example, a common cold remedy tends to dry up milk, sometimes permanently.


Herbal remedies, while seeming more natural, are also not necessarily safe when nursing.  Even teas may be a problem for a nursing mother or her baby.


So what are the best sources of information for you if you need to use a medication? One of my favorites, if you have Internet access, is the U.S. National Library of Medicine’s LactMed website, at http://lactmed.nlm.nih.gov.  While intended for healthcare providers, it is easy to understand and you can print out the page if you want to share it with your doctor.


Another resource for pregnant and nursing mothers is The InfantRisk Center run by Dr. Thomas Hale, Pharm.D.  They provide up-to-date information to both healthcare providers and pregnant and nursing mothers.  They are open to answer calls during the week Monday through Friday from 8am to 5pm (Central Standard Time) at (806) 352-2519.


When answering calls on our Breastfeeding Warmline beginning in 1982, we discovered that the number one call into the phone line were questions about the safety of medications.  When I wrote “The Nursing Mother’s Companion”, I knew I wanted a great resource for mothers to have on the safety of drugs while nursing.  I was able to enlist the help of Dr. Phillip Anderson, Pharm.D., who ran one of the country’s first Drug Information Line for pregnant and nursing mothers at U.C. San Diego. Dr. Anderson is also the person who created LactMed several years ago. He wrote a wonderful guide for breastfeeding mothers in my book and we have it updated every five years. So, if you own a copy of “The Nursing Mother’s Companion”, you will have his great easy-to-use guide on most every drug at your finger tips 24 hours a day.