Breastfeeding and Medications: what you need to know

Breastfeeding and medications: How much drug ends up in the child?

Breastfeeding and taking medication at the same time is only acceptable if the active ingredient does not pass into the mother’s milk or the absorption is harmless for the infant. However, before a drug absorbed by the mother during the breastfeeding period has an effect on the infant, the active substance must first pass from the mother’s blood into the milk and from there via the infant’s gastrointestinal tract into its bloodstream.

Not every substance manages this equally well. Among other things, its concentration is often greatly minimized by degradation and conversion processes. The so-called pharmacokinetics of an active ingredient determine how harmful breastfeeding and drug intake can be for the infant. The important factors here are the absorption and distribution of the drug, its biochemical conversion and degradation (metabolization), and its excretion – first in the mother’s body and then in the infant’s body.

Breastfeeding and drugs: concentration in milk

In women who are breastfeeding and taking medications, their concentration in breast milk depends on the:

• drug concentration in maternal blood (plasma): The higher this is, the more enters breast milk.
• Molecule size: small molecules pass directly, with larger ones, fat-soluble molecules in particular accumulate in the milk.
• Plasma protein binding: Only unbound active ingredients enter the milk.

Breastfeeding and drugs: Infant factors

Unlike during pregnancy, your baby is fully developed after term birth and his metabolism is already quite active. This means that harmful substances do not affect him quite as much as they did when he was still a fetus.

However, not everything runs like an adult yet: The infant’s liver and kidneys do not yet work as quickly. Protein binding in the plasma is also lower, which increases the effectiveness of a drug in the infant, especially in the first few months. In addition, the infant’s intestinal wall is still very permeable, absorption is slowed down, the blood-brain barrier is not yet fully developed, the pH value in the stomach is higher, and the child has fewer pancreatic enzymes and bile acid.

The amount drunk also plays a role, which is why, especially in the case of fully breastfed babies, careful consideration must be given to whether any of the mother’s medications cause negative reactions in the child.

Breastfeeding and medications: What should be considered?

Before you breastfeed while taking medication, you can first try to manage your symptoms with home remedies. For everyday ailments such as gastrointestinal problems, colds or minor aches and pains, home remedies are often a good alternative during breastfeeding. For homeopathic remedies, the D6 potency is recommended during breastfeeding, namely in the form of tablets and globules. Alcoholic drops should be avoided during breastfeeding.

If these remedies do not help or if it is a more serious disease, you must clarify possible risks with your doctor before using medicines despite breastfeeding. You should also seek professional advice on herbal medicines and avoid non-controlled products, as they may be contaminated by pesticides or heavy metals. Some pharmacies hold the “child-friendly pharmacy” certification and can provide you with qualified advice.

• Only take medicines with active ingredients that have been tried and tested over a long period of time and are considered to be harmless
• Better mono than combination preparations
• No retard preparations (= preparations with delayed release of active ingredient), as the concentration of active ingredient in the blood then remains constantly high for a long time
• Short-acting agents with short half-lives are better
• Weigh benefits and risks carefully: As little as possible, as much as necessary!
• Reduced intake, if possible only once a day after the breastfeeding meal, at best when experience shows that the child sleeps longer after drinking.
• Women who are breastfeeding and taking medication should take any unusual drinking behavior, faintness or restlessness on the part of their baby seriously and seek medical clarification to be on the safe side.

Breastfeeding and medication for everyday illnesses

Breastfeeding and medication for colds

Breastfeeding and medication for pain

Migraine, headache, toothache, pain after surgery or cesarean section – you don’t have to brave these unnecessarily during breastfeeding. In addition to paracetamol, ibuprofen is suitable for pain relief during breastfeeding. Local anesthesia (local anesthetic), such as at the dentist, is also possible.

Breastfeeding and medication for gastrointestinal complaints

Constipation, flatulence and heartburn can make life difficult. But you don’t always have to take medication right away. Digestive problems can often be eliminated by a change in diet. More fruit and flaxseed on the menu or a renunciation of flatulent foods can already help.

If a healthy diet does not help, you may use proton pump blockers for reflux or gentle remedies for flatulence.

In the case of diarrhea or vomiting, medications for relief are acceptable even when breastfeeding, if necessary.

Breastfeeding and hormonal contraception medications

Breastfeeding and medication: suitable or not?

When it comes to everyday illnesses, we usually resort to tried-and-tested remedies without giving it much thought. The table shows how breastfeeding and medications are to be evaluated in detail. It does not claim to be complete!

If you are breastfeeding and need medication, you must discuss taking it with your doctor. Particularly with a premature, small or sick infant, caution is always advised! However, you should never stop taking important medication on your own initiative out of concern for your child. Often a good solution for mother and child can be found in consultation with the doctor.

Medication	Rating
Painkillers
Paracetamol	Suitable painkiller for breastfeeding, first choice
Suitable during breastfeeding, 1st choice drug
Acetysalicylic acid (ASS, Aspirin)	Breastfeeding and the occasional intake of 1.5 g per day or external use are acceptable; regular and in higher doses not acceptable: better ibuprofen or paracetamol!
When breastfeeding occasional acceptable, better ibuprofen or paracetamol!
Only under medical supervision: risk of opioid intoxication!
Antibiotics
Penicillin	1st choice antibiotic for breastfeeding; no side effects in infant, occasional mushy stools
Possible during breastfeeding; occasionally thin stool/diarrhea in infant
Cephalosporin (Cefaclor)	Antibiotic of choice in breastfeeding; in infant, occasional thin stools, rarely diarrhea.
Caution in premature infants and neonates with hyperbilirubinemia or glucose-6-phosphate dehydrogenase deficiency! Better suited antibiotics for breastfeeding are penicillin, cephalosporin or erythromycin!
Nasal sprays
Xylometazoline (Olynth, Otriven) or Oxymetazoline (Nasivin)	Nasal spray during breastfeeding okay for short-term use, no symptoms in breastfed infants despite extensive use; no data on transfer to breast milk, but local application presumably results in little transfer
Reflux/heartburn
Breastfeeding possible; high protein binding in plasma and low oral availability when absorbed with breast milk, therefore no symptoms expected; infant dose well below therapeutic dose for infants.
Hydrotalcite or Magaldrate	No oral bioavailability, no evidence of symptoms in breastfed infants; may be used as indicated during breastfeeding.
Diarrhea
Loperamide (Imodium)	Possible transiently in breastfeeding; low relative dose, so no symptoms expected in breastfed infants; few documented reports of use in breastfeeding.
Constipation
Sodium picosulfate (Laxoberal) Bisacodyl (Dulcolax)	Studies showed no drug in breast milk; no intolerance expected in breastfed infants; breastfeeding is possible without restrictions.
Lactulose (Lactuverlan)	No reports of symptoms in breastfed infants on maternal lactulose therapy; among laxatives of choice in breastfeeding.
Flatulence
Simeticon/Dimeticon	May be used during lactation; neither is absorbed from the intestine, so no adverse effects expected.
Vomiting
Dimenhydrinate (Vomex A)	Antihistamine, therefore symptoms such as sedation or hyperexcitability in breastfed infant not excluded; acceptable for a few days.
Allergy
Occasional ingestion possible during breastfeeding; no significant intolerance.
Other antihistamines: fexofenadine, azelastine, dimetindene	Prolonged therapy may cause sedation or hyperexcitability in breastfed infant; antihistamines of choice are loratadine or cetirizine.
Budesonide (inhaled glucocorticoid).	No known symptoms in breastfed infant; agent of choice for asthma; low oral bioavailability, so oral/rectal use is also safe for breastfed infant.
Cromogcilic acid	May be used; low absorption and short half-life, so probably unlikely to pass into breast milk.
Cortisone (prednisolone, prednisone)	If taken once or over a short period of time, even up to 1g/day harmless; for long, higher doses better not breastfeed 3-4 h after taking cortisone, if necessary pause breastfeeding or wean, medical consultation advisable; local external application harmless; up to 10 mg/day not detectable in milk.
Hormonal contraception
Progestogen-containing hormone preparations	Only progestogen-containing agents possible during breastfeeding: mini-pill, three-month injection, contraceptive sticks or hormonal IUD.
Estrogen-containing hormone preparations
Herpes simplex, zoster
Breastfeeding possible with local and systemic therapy; sometimes detectable in infant serum, but no abnormalities.
Antidepressants
SSRI	Selective serotonin reuptake inhibitors (SSRIs) such as sertraline are currently the most prescribed antidepressants. Sertraline is one of the antidepressants of choice in breastfeeding.

Breastfeeding: Medications that harm the baby

Sometimes neither a home remedy will help nor are there any harmless alternatives to a medication. In addition, some diseases require a longer or permanent therapy or the use of a drug that is harmful to the baby. The following preparations or therapies therefore require a break from breastfeeding or complete weaning:

• Cytostatic drugs (for cancer – as chemotherapy – or for autoimmune diseases))
• Radionuclides
• Opioids
• Combination therapies with several psychotropic or antiepileptic drugs, especially combinations with lamotrigine, benzodiazepines, or lithium
• Medications containing iodine, such as iodine-containing contrast media
• iodine-containing disinfectants for large-area disinfection

Breastfeeding and medications: Breastfeeding break or weaning?

Sometimes a break from breastfeeding is not enough, for example if women who are breastfeeding have to take medication for a long time or permanently. In this case, stopping breastfeeding may be a better solution. Discuss this with your doctor!