Breastfeeding and drugs

Abstract

Key content Most commonly used medications such as paracetamol, most antibiotics and inhalers are considered safe for women to use during lactation. Most drugs taken by a breastfeeding woman will be expressed in small volumes in the breast milk. The amount depends on several factors, including the drug dose, the size of the molecule, the protein binding and lipid solubility of the drug, the age of the infant and volume of milk consumed. Data regarding short‐term and long‐term effects of maternal medication use on breastfed infants are limited. There is no direct evidence of impaired lactation with most commonly used medications, but some medications, such as decongestants (pseudoephedrine/phenylephrine), high‐dose diuretics and the combined oral contraceptive pill, may inadvertently adversely affect maternal milk supply. Women need accurate and balanced advice regarding safety of medication in breastfeeding to avoid early or inappropriate cessation of medications in the lactation period. Learning objectives Understand the pharmacokinetics of common medications used in the lactation period. Understand the impact of drugs on the breastfed infant. Be familiar with the current literature on drug safety and lactation to enable appropriate counselling.