Fort Worth, Texas,
05:36 PM

Read this before taking medication and breastfeeding

Ask yourself and your doctor these questions

Anything in blood stream could be transmitted to breast milk: food, drug (over the counter medicine, prescription, oral and other) alternative/herbal medicines. Because of this, when you are breastfeeding, it is important to notify your pediatrician about everything you are taking.

When deciding about starting a medication as a breastfeeding mother, here are some questions that need to be considered:

1. Has the medication been studied in humans or other mammals?

2. How important is the medication to the mother?  For example, what would happen if the mother did not take the medicine?

Clearly if something is well studied, safe and very important for mom, go for it. If something has been shown to be unsafe and not important, then skip it. In my mind, everything I see is a gray area. If you are not impressed with the helpfulness of this “brilliant” analysis, here are some resources you can use:

  1. Your pediatrician or obstetrician. I don’t memorize all the possible drugs, but I do know where to look them up.
  2. Infant Risk -Dr. Hale from Texas Tech is one of the national leaders in medication use during pregnancy and while breastfeeding.
  3. LactMed –The National Library of Medicine’s Drug and Lactation Database

A Special Consideration: Anti-Depressant and Anti-Anxiety Medications

Because of the relatively small number of breastfeeding mothers on anti-depressants, they are still mostly unstudied. Many have been found to enter the bloodstream at less than 2 percent of the dose (adjusted for the babies weight), but some do reach higher levels (near 10 percent).

Here are some of the ones that enter at higher levels:

  • Buproprion
  • Fluoxetine
  • Lithium
  • Venlafaxine
  • Diazepam
  • Citalopram
  • Lamotrigine

Even though we know this, we still don’t know the effects of the medication on the baby is in many ways. The AAP statement highlights the fact that these medications tend to have a build up over time. It is important to note also that baby’s kidneys and liver function (the primary way the we get rid of medications) are not fully mature. Because of this, I evaluate each mother/baby combination by these 3 criteria:

  • Benefits of breastfeeding
  • Risk of the medication
  • Risks of mom’s depression on the child

In summary, I believe we should use caution with all medications with breastfeeding mothers.  If you are breastfeeding, please consult with your pediatrician or obstetrician prior to taking any medication.

About the author

Justin Smith, M.D., is a pediatrician at the Cook Children’s Pediatrics Lewisville. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his three young children, exercising, reading and writing about parenting and pediatric health issues.

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LactMed has a great free app! I'm glad to know its a resource you recommend.