Drugs and Breastfeeding

For all the benefits of breastfeeding, there may be circumstances that put the baby at risk, making it necessary to discontinue or temporarily interrupt breastfeeding. In this case, the risk may come from the mother herself, for example, through the use of medications. Almost every active ingredient passes into breast milk and thus enters the child’s organism. On its way, the active ingredient is subjected to various degradation and conversion processes, which reduce its concentration both in the mother’s organism and subsequently in the child’s organism. Only rarely does the active ingredient achieve a therapeutic effect in the child. However, with prolonged or regular use, the substance can accumulate in the child and lead to symptoms. This is exacerbated by the fact that the baby’s intestinal wall is still more permeable, the bloodbrain barrier is not yet fully developed and the detoxification function of the baby’s liver and kidneys is still limited. The production of pancreatic enzymes (pancreatic enzymes) and bile acids is still low. Premature and newborn infants and sick babies are particularly at risk. Ultimately, it is always difficult to assess how the child’s organism will react to a drug in an individual case, since the metabolization (metabolization) of drugs varies from person to person. The so-called milk plasma quotient can be used to evaluate an active substance/medication during the breastfeeding period. It indicates the concentration of the substance in breast milk in relation to the maternal plasma concentration. If the quotient is < 1, the accumulation in breast milk is negligible. Even more appropriate is the relative dose of an active substance/drug. It indicates the proportion of the mother’s weight-related daily dose that a fully breastfed infant receives per kg of its body weight in 24 hours with the milk. If the relative dose of an active ingredient is no more than 3%, no break in breastfeeding is necessary for short-term use.Active ingredients that may also be prescribed directly to the infant are also considered to be well tolerated by breastfeeding. The following symptoms should be observed in the child after the mother has taken the medication: Restlessness, weakness in drinking, drowsiness. The risk of toxic manifestations is higher for young infants (although very low overall), since older babies are breastfed only once or twice a day. Medications also have effects on milk production. The following medications reduce milk volume via lowering prolactin levels:

  • Diuretics (dehydrating medications).
  • Dopamine agonists (e.g., in Parkinson’s disease, restless legs syndrome): bromocriptine, cabergoline – dopamine agonists are used for weaning
  • Estrogens (female sex hormones).

The following drugs increase the amount of milk via an increase in prolactin levels:

The following should be considered when taking medications while breastfeeding:

  • Before taking a drug, check whether there is a herbal alternative that is safer. In the case of more serious diseases of the mother, this is usually not possible.
  • Medications that the mother must take permanently, must not be independently discontinued for fear of harming the baby.
  • Always consult with the midwife, the attending physician or pediatrician.

Generally speaking:

  • Responsible and not frivolous use of medicines!
  • As little medication as possible, as much as necessary!

In the majority of cases, breastfeeding compatible alternatives can be found for most medications. If the breastfeeding woman has to take medication permanently due to a chronic disease or if it is a combination therapy, it must be considered in each individual case whether a break in breastfeeding or weaning should take place. Risk factors are:

  • CNS-active substances (used to treat diseases of the central nervous system).
  • Immature infant
  • Age of the child < 2 months.

For information on the suitability of an agent/medication during breastfeeding, see:

  • Pharmacovigilance and Advisory Center for Embryonic Toxicology – Charité-Universitätsmedizin Berlin (2017) Drug safety in pregnancy and lactation.

The following is an overview of (conditionally) breastfeeding compatible drugs for everyday complaints as well as diseases:

Complaints/diseases Active ingredients Notes
Common colds
Headache, aching limbs, fever
  • Paracetamol
Sniffles
  • Oxymetazoline
  • Xylometazoline
  • Usable for a short time
  • Prefer children’s dosage
  • Avoid combination products
Pain
Headache
  • Paracetamol
  • Ibuprofen
Migraine
  • Paracetamol
  • Ibuprofen
  • Sumatriptan
  • Metoprolol – for the prophylaxis of mirgai.
Toothache
  • Paracetamol
  • Ibuprofen
  • In the context of dental treatment is allowed local anesthesia
Gastrointestinal tract (gastrointestinal tract)
Pyrosis (heartburn)
  • Antacids:
    • Hydrotalcite
    • Magaldrate
  • Proton pump inhibitors:
    • Oemprazole
    • Pantoprazole
Nausea/vomiting
  • Dimenhydrinate
  • Temporarily acceptable
  • May cause sedation (calming) or hyperexcitability in the infant
Meteorism (flatulence)
  • Dimeticone
  • Simeticon
Diarrhea (diarrhea)
  • Loperamide
  • Temporarily possible
Constipation (constipation)
  • Lactulose (drug of choice)
  • Sodium picosulfate
  • Bisacodyl
Allergy and allergic symptoms
Allergy Remedies of choice are:

  • Cetirizine
  • Loratidine
  • Cortisone
    • Prednisolone
    • Prednisone
  • Regarding loratidine: symptoms such as restlessness, sedation, dry mouth, as well as tachycardia (increased pulse rate) in the infant are possible, but rather improbable
  • Regarding cortisone:
    • Maximum safe daily dose: 1 g
    • If a higher dose is required over a longer period of time, do not breastfeed for 3-4 hours after ingestion
    • A local external application is harmless
Bronchial asthma
  • Budesonide (inhalation spray)
Women’s Health
Contraception (contraception)
  • Preparations containing progestin only (no estrogen!).