With the middle of cold season among us, it's extremely important for breastfeeding women to learn all they can about how over-the-counter cold medications and other medicines can affect their milk production, along with the other side effects that may come with taking cold medicine. From common medications like Tylenol and Advil or others containing ibuprofen, acetaminophen, as well as decongestants, it can be hard to know what effects these may have on lactation.
Labels, misinformation, outdated information, and access to online sources make navigating the use of medications while breastfeeding and pumping quite complicated. Here is a good starting place to gather what information is actually needed, common myths, and resources to check and discuss with your healthcare provider.
What to Consider For Breastfeeding MomsIngredientsNot all similar types of medications and supplements are created equally, both in specific ingredients, active ingredients, and concentration or dosage. Pain medications are a great example of this. Some medications are fine to use while pregnant, but not while breastfeeding and pumping, and vice versa. Many over-the-counter (OTC) and prescription (Rx) medications are actually fine to take while continuing to provide breastmilk. For the medications that are contraindicated, there is almost always an alternative.Combinations of medications and other lifestyle considerationsIf starting a new medication and or supplement, consider interactions that may happen. Concentrations, efficacy, absorption efficacy, and side effects that may occur in your breastmilk, milk production, and lactation overall are all things to discuss with a care provider knowledgeable in these areas. Alcohol use may be advised against, as well. Read here for information on alcohol use while lactating.Side Effects and AbsorptionBreastmilk and the systems in charge of creating breastmilk do a fantastic job in actually filtering out or limiting substances that are not supposed to be a part of the composition. This includes drugs like nicotine and caffeine. Many medications are subject to this, as well. In fact, the common concern with medications while breastfeeding is not as much the possibility of entering the breastmilk as it is the mother’s function in producing the milk effectively and efficiently. Gestational age of the infant and any conditions that may consider them fragile or at risk are other considerations to make when discussing over-the-counter medications.Half-life
If a drug is prescribed or chosen to take for a limited amount of time, and is also contraindicated to take while lactating, it is important to know how long it stays in the system before becoming metabolized and eliminated. This will also dictate the need for temporary weaning, pumping and dumping, or prolonged feeds. Knowing ahead of time may avoid these issues, as protecting milk supply capabilities as well the mother’s wishes is of priority. In extreme cases, re-lactation may not always prove to be successful enough for exclusivity, and may require supplementation, increasing the risk of overall cessation of providing breastmilk.Long-term Use and PlansKnowing how long a medication is needed to be taken is a crucial factor for some medications. Antidepressants and pain medications, for example, are common medications that need to be carefully selected when breastfeeding or planning to breastfeed, as some are not safe to use, and are often used for an extended amount of time. Talk with your care provider about durations, transitions to new or different medications, and what the change in status (prenatal, pregnant, breastfeeding/pumping) may mean for your medications.Research and Sources of InformationInformation on medications needs to be up-to-date! Like with many subjects, misinformation and outdated information still circulate. Not just in blogs, but in the medical field, too. When in doubt, ask for article references that back up the information given. Many professionals not trained specifically for lactation may not be comfortable or knowledgeable enough to answer medication and anesthetic questions. Even with medications many may consider common and with a simple answer like cough suppressant medications, nasal sprays, etc., it's best practice to check with a healthcare professional and do your research as well.Cold Remedies & Alternatives To MedicationsWhile some medicines may need to be completely avoided, there are alternatives available with others. Ask about and discuss these options with your care provider. Low risk, comfort measures are also a great route to take in substitution of certain medications.
For example, since so many medications used for cold and sinus relief should not be used while lactating, other methods to treat the symptoms and boost the immune system are:
- Steam, hot showers
- Garlic and turmeric (anti inflammatory properties)
- Citrus fruits and green, leafy vegetables for vitamin C
- Eggs, bone broth, mushrooms, dairy, and sunlight for vitamin D
- Hanging eucalyptus in the shower or diffusing the oil
- Epsom Salt baths (great source of magnesium!)
- Fluids; drinking water and electrolytes helps flush the body
Common Medications to Avoid or Seek Alternative During BreastfeedingCold, Sinus and AllergyMany of these medications contain antihistamines, such as pseudoephedrine, designed to dry up or reduce mucous secretions. Coincidently, these have also been shown to dramatically reduce milk supply capabilities as well, as the medications cannot specifically target sinus drainage.Pain MedicationsSome pain medications should not be taken while pumping or breastfeeding, most often due to their half life and passing into milk supply, possibly risking ingestion. Discuss with your care provider or pharmacist about a safe option.Antidepressants and Psychotropic DrugsThere are, indeed, options for women needing help in this area, regardless if pregnant or lactating. However, like with other drugs, some options are not recommended. Discuss an option with minimal side effects and minimal absorption or effects on breastmilk quality.AntibioticsWhen being prescribed antibiotics, be sure to let the provider know your breastfeeding status as these can affect lactation. 
Birth ControlAs the function of lactation is a heavily hormonal-driven function, hormone control is a touchy area. Low-to-no hormone options are preferred, such as an IUD or mini pill.ResourcesLactMed and the NIHLactMed is a free tool, also available in their user-friendly app, from the National Institute of Health that allows searches for both over-the-counter (OTC) and prescription (Rx) medications to check on the indications of taking them while breastfeeding, along with providing possible alternatives if the one in question is contraindicated. Having this reliable, research- and evidence-based information handy will help navigate options, as well as aid in any discussions with the doctor.Free App from the NIH
Help Line
The InfantRisk Center (1-806-352-2519), headed by Dr. Thomas Hale in the US, has a phone helpline and additional information on medication use during pregnancy and breastfeeding.
References:
1. Thomas Hale, RPh, PhD (Medications and Mothers’ Milk 2014, p. 7-12) Breastfeeding and Medication, American Academy of Pediatrics, https://www.aap.org/en-us/Pages/Breastfeeding-and-Medication.aspx
2. LactMed: A TOXNET DATABASE, National Institute of Health (NIH), https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
3. “How do I determine if a medication is safe for a breastfeeding mother?” Kelly Mom Parenting and Breastfeeding, https://kellymom.com/hot-topics/med-risks/
With the middle of cold season among us, it's extremely important for breastfeeding women to learn all they can about how over-the-counter cold medications and other medicines can affect their milk production, along with the other side effects that may come with taking cold medicine. From common medications like Tylenol and Advil or others containing ibuprofen, acetaminophen, as well as decongestants, it can be hard to know what effects these may have on lactation.
Labels, misinformation, outdated information, and access to online sources make navigating the use of medications while breastfeeding and pumping quite complicated. Here is a good starting place to gather what information is actually needed, common myths, and resources to check and discuss with your healthcare provider.
What to Consider For Breastfeeding MomsIngredientsNot all similar types of medications and supplements are created equally, both in specific ingredients, active ingredients, and concentration or dosage. Pain medications are a great example of this. Some medications are fine to use while pregnant, but not while breastfeeding and pumping, and vice versa. Many over-the-counter (OTC) and prescription (Rx) medications are actually fine to take while continuing to provide breastmilk. For the medications that are contraindicated, there is almost always an alternative.
Combinations of medications and other lifestyle considerationsIf starting a new medication and or supplement, consider interactions that may happen. Concentrations, efficacy, absorption efficacy, and side effects that may occur in your breastmilk, milk production, and lactation overall are all things to discuss with a care provider knowledgeable in these areas. Alcohol use may be advised against, as well. Read here for information on alcohol use while lactating. Side Effects and AbsorptionBreastmilk and the systems in charge of creating breastmilk do a fantastic job in actually filtering out or limiting substances that are not supposed to be a part of the composition. This includes drugs like nicotine and caffeine. Many medications are subject to this, as well. In fact, the common concern with medications while breastfeeding is not as much the possibility of entering the breastmilk as it is the mother’s function in producing the milk effectively and efficiently. Gestational age of the infant and any conditions that may consider them fragile or at risk are other considerations to make when discussing over-the-counter medications.
If a drug is prescribed or chosen to take for a limited amount of time, and is also contraindicated to take while lactating, it is important to know how long it stays in the system before becoming metabolized and eliminated. This will also dictate the need for temporary weaning, pumping and dumping, or prolonged feeds. Knowing ahead of time may avoid these issues, as protecting milk supply capabilities as well the mother’s wishes is of priority. In extreme cases, re-lactation may not always prove to be successful enough for exclusivity, and may require supplementation, increasing the risk of overall cessation of providing breastmilk.Long-term Use and PlansKnowing how long a medication is needed to be taken is a crucial factor for some medications. Antidepressants and pain medications, for example, are common medications that need to be carefully selected when breastfeeding or planning to breastfeed, as some are not safe to use, and are often used for an extended amount of time.
Talk with your care provider about durations, transitions to new or different medications, and what the change in status (prenatal, pregnant, breastfeeding/pumping) may mean for your medications.Research and Sources of InformationInformation on medications needs to be up-to-date! Like with many subjects, misinformation and outdated information still circulate. Not just in blogs, but in the medical field, too. When in doubt, ask for article references that back up the information given. Many professionals not trained specifically for lactation may not be comfortable or knowledgeable enough to answer medication and anesthetic questions. Even with medications many may consider common and with a simple answer like cough suppressant medications, nasal sprays, etc., it's best practice to check with a healthcare professional and do your research as well.
