Breastfeeding and medication

and Sabine Schrör, medical journalist Updated on

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

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Mothers who breastfeed and take medication are often confused: Does the active ingredient pass into breast milk and, if so, does it harm the baby? Some women then have to decide whether to stop breastfeeding or not. Read here what you have to pay attention to when breastfeeding with medication, which means are safe and when a breastfeeding break or weaning is actually unavoidable.

Breastfeeding and medication: 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 breast milk or if it is safe for the infant to absorb. Before a drug taken by the mother has an effect on the baby while breastfeeding, the active ingredient must first get from the mother's blood into the milk and from there via the baby's gastrointestinal tract into the baby's bloodstream.

Not every substance does this equally well. Among other things, his concentration is often greatly minimized by dismantling and remodeling processes. The so-called pharmacokinetics of an active ingredient determine how harmful breastfeeding and medication intake can be for the baby. What is important here is the uptake (absorption) and distribution (distribution) of the drug, its biochemical conversion and degradation (metabolism) as well as its elimination (excretion) - first in the mother's body and then in the child's body.

Breastfeeding and medication: concentration in milk

Basically, almost every active ingredient passes into breast milk, but to a different extent. Most drugs do not achieve a therapeutically effective dose in milk when dosed correctly. Problematic concentrations are rarely measured. However, with prolonged or long-term use, a constant, higher level of the active ingredient in breast milk can set in, which may be problematic for the baby.

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

• Drug concentration in maternal blood (plasma): the higher this is, the more it gets into the breast milk.
• Molecular size: Small molecules pass over directly, while larger ones mainly accumulate fat-soluble molecules in the milk.
• Plasma protein binding: Only unbound active ingredients get into the milk.

Breastfeeding and Medication: Childhood Factors

Unlike during pregnancy, when your baby is born on time, your baby is fully developed and its metabolism is already quite active. This means that pollutants no longer bother him as much as they did when he was a fetus.

However, not everything is going as it does in an adult: the infant's liver and kidneys are not yet working as quickly. Protein binding in the plasma is also lower, which increases the effectiveness of a drug in babies, especially in the first few months. In addition, the child'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 acids.

In the case of premature or newborn babies in particular, it is difficult to predict how the child's organism will react to medication in the milk in individual cases after breastfeeding. Even after good advice from the doctor or pharmacist, correct dosage and strict adherence to the intake of a harmless agent, it is difficult to assess the reaction in the infant individually: Everyone metabolizes drugs differently - sometimes faster and sometimes slower, depending on their personal genetics.

The amount of water you drink also plays a role, which is why it is necessary to carefully check whether the mother's medication causes negative reactions in the child, especially in the case of fully breastfed babies.

Breastfeeding and medication: what should be considered?

Before breastfeeding and taking any medication, you can first try to manage your symptoms with home remedies. For everyday illnesses such as gastrointestinal problems, colds or mild pain, home remedies are often a good alternative during breastfeeding. In the case of homeopathic remedies, the D6 potency is recommended in the form of tablets and globules during breastfeeding. You should avoid drops containing alcohol during breastfeeding.

If these remedies do not help or if the disease is more serious, you must clarify the possible risks with your doctor before using any medication despite breastfeeding. You should also seek professional advice with herbal medicines and avoid uncontrolled products as they can be contaminated with pesticides or heavy metals. Some pharmacies have the "child-friendly pharmacy" certification and can provide you with qualified advice.

If medication is unavoidable when breastfeeding, the following points should be observed:

• Only take medication with active ingredients that have been tried and tested for a long time and are considered to be harmless
• Better mono than combination preparations
• No sustained-release preparations (= preparations with delayed release of active ingredients), as the active ingredient concentration in the blood then remains consistently high for a long time
• Better short-acting agents with a short half-life
• Carefully weigh the benefits and risks: as little as possible, as much as necessary!
• Reduced intake, if possible only once a day after breastfeeding, at best when experience shows that the child sleeps longer after drinking.
• Women who breastfeed and take medication should take unfamiliar drinking behavior, fatigue or restlessness of their baby seriously and have them checked by a doctor to be on the safe side.

Breastfeeding and medication for everyday illnesses

Breastfeeding and medication for colds

Cold symptoms can often be treated well with home remedies such as inhalations, nasal rinses, or poultices. If they do not help enough, paracetamol is the drug of choice for headaches, body aches and fever during breastfeeding. Avoid combination preparations for colds. You can use decongestant nasal spray for a short time, usually the children's dose is sufficient. If it has to be an antibiotic (for bacterial infections), penicillin is well tolerated as a drug during breastfeeding and the first choice.

Breastfeeding and pain medication

Migraines, headaches, toothache, pain after surgery or caesarean section - you don't have to be unnecessarily brave even when breastfeeding. In addition to paracetamol, ibuprofen is suitable for pain relief during breastfeeding. A local anesthetic (local anesthetic), for example at the dentist, is also possible.

Breastfeeding and medication for gastrointestinal complaints

Constipation, gas, and heartburn can make life difficult. But you don't always have to take a drug straight away. Digestive problems can often be eliminated by changing your diet. More fruit and flaxseed on the menu or avoiding flatulent foods can help.

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

In the case of diarrhea or vomiting, medication to relieve breastfeeding is acceptable, if necessary.

Breastfeeding and hormonal contraception medication

Breastfeeding and hormonal birth control drugs are problematic when estrogen comes into play. Whether as a pill, vaginal ring or contraceptive patch: the hormones end up in breast milk and thus in the infant. In addition, estrogens impair milk production. An alternative are preparations that only contain progestin (such as the mini pill).

Breastfeeding and Medication: Suitable or Not?

With everyday illnesses, we usually resort to tried and tested means without thinking too much. The table shows how breastfeeding and medication are to be assessed in detail. It does not claim to be complete!

If you are breastfeeding and require medication, you must discuss the intake with your doctor.Caution is always required, especially with a premature, small or sick baby! However, you should never stop taking important medication yourself out of concern for your child. A good solution for mother and child can often be found in consultation with the doctor.

drug	valuation
Painkiller
Paracetamol	Suitable pain reliever for breastfeeding, first choice
Ibuprofen	Suitable for breastfeeding, 1st choice product
Acetysalicylic acid (ASA, aspirin)	Breastfeeding and the occasional intake of 1.5 g per day or external use are justifiable; regular and unacceptable in higher doses: better ibuprofen or paracetamol!
Diclofenac	Occasionally acceptable when breastfeeding, ibuprofen or paracetamol is better
Codeine	Only under medical supervision: Risk of opioid intoxication!
Morphine	Only briefly and occasionally under medical supervision: worsens breathing!
Antibiotics
penicillin	First choice antibiotic for breastfeeding; no side effects in the infant, occasional mushy stool
Erythromycin	Possible during breastfeeding; Occasionally thin stool / diarrhea in the infant
Cephalosporin (Cefaclor)	Antibiotic of choice when breastfeeding; occasional thin stool in the infant, rarely diarrhea.
Co-trimoxazole	Beware of premature babies and newborns with hyperbilirubinemia or glucose-6-phosphate dehydrogenase deficiency! More suitable antibiotics for breastfeeding are penicillin, cephalosporin or erythromycin!
Nasal sprays
Xylometazoline (Olynth, Otriven) or Oxymetazoline (Nasivin)	Nasal spray when breastfeeding for short-term use okay, no symptoms in breastfed infants despite extensive use; no data on excretion in breast milk, but presumably only minor excretion due to local application
Reflux / heartburn
Omeprazole	Breastfeeding possible; high protein binding in plasma and low oral availability when ingested with breast milk, therefore no symptoms to be expected; Child dose well below the therapeutic dose for infants.
Pantoprazole	Breastfeeding possible; low transfer into breast milk; only individual case reports, so far no abnormalities in breastfed infants.
Hydrotalcite or magaldrate	No oral bioavailability, no evidence of symptoms in breastfed children; may be used as indicated during breastfeeding.
diarrhea
Loperamide (Imodium)	Temporarily possible during breastfeeding; low relative dose, therefore no symptoms to be expected in breastfed children; hardly any documented reports on use during breastfeeding.
constipation
Sodium Picosulfate (Laxoberal) Bisacodyl (Dulcolax)	Investigations revealed no drug in breast milk; no intolerance to be expected in breastfed infants; Breastfeeding is possible without restrictions.
Lactulose (lactuverlan)	No reports of symptoms in breastfed children on maternal lactulose therapy; is one of the laxatives of choice for breastfeeding.
Flatulence
Simeticon / Dimeticon	May be used during breastfeeding; neither are absorbed from the intestine, so no negative effects are to be expected.
Vomit
Dimenhydrinate (Vomex A)	Antihistamine, therefore symptoms such as sedation or overexcitability in the breastfed infant cannot be ruled out; acceptable for a few days.
allergy
Cetirizine	Occasional use possible when breastfeeding; no significant intolerance.
Loratadine	Symptoms such as restlessness, sedation, dry mouth and tachycardia in breastfed infants cannot be completely ruled out, but are rather unlikely; in addition to cetirizine, the agent of choice for breastfeeding.
Other antihistamines: fexofenadine, azelastine, dimetinden	In the case of long therapy, sedation or over-excitability in the breastfed infant is possible; The antihistamines of choice are loratadine or cetirizine.
Budesonide (inhaled glucocorticoid)	No symptoms known in the breastfed infant; Drug of choice for asthma; low oral bioavailability, therefore oral / rectal use also harmless for breastfed infants.
Cromogcilic acid	May be used; low absorption and short half-life, therefore presumably hardly any transfer into breast milk.
Cortisone (prednisolone, prednisone)	With a single ingestion or over a short period of time, up to 1g / day is harmless; with longer, higher doses better 3-4 hours after taking cortisone, do not breastfeed, if necessary, pause or wean, medical consultation advisable; local external application harmless; up to 10 mg / day not detectable in milk.
Hormonal contraception
Hormone preparations containing progestin	Only progestogen-containing agents are possible during breastfeeding: minipill, three-month injection, contraceptive stick or hormonal IUD.
Hormone preparations containing estrogen	Estrogen reaches the child through breast milk and reduces the amount of milk: vaginal ring patches or pills are not suitable for breastfeeding!
Herpes simplex, zoster
Acyclovir	Breastfeeding possible with local and systemic therapy; sometimes detectable in the serum of infants, but no abnormalities.
Antidepressants
SSRI	Selective serotonin reuptake inhibitors (SSRIs) such as sertraline are currently the most commonly prescribed antidepressants. Sertraline is one of the antidepressants of choice for breastfeeding.

Breastfeeding: drugs that harm the baby

Sometimes a home remedy does not help, and there are no harmless alternatives to a drug. In addition, some diseases require longer or permanent therapy or the use of a drug that is harmful to the infant. The following preparations or therapies therefore require a break in breastfeeding or complete weaning:

• Cytostatics (for cancer - as chemotherapy - or for autoimmune diseases)
• Radionuclides
• Opioids
• Combination therapies with several psychotropic or anti-epileptic drugs, especially combinations with lamotrigine, benzodiazepines or lithium
• Medicines that contain iodine, such as contrast agents containing iodine
• iodine-containing disinfectants for large-scale disinfection

Breastfeeding and Medication: Breastfeeding Break or Weaning?

If breastfeeding and medication do not get along, this does not necessarily mean the final end of breastfeeding. Instead, many women take a break from breastfeeding during therapy. It is then important to maintain milk production by expressing regularly. You pour away the milk that has been contaminated with medication. Instead, your child will be given industrially produced milk. You may be able to express a supply of drug-free breast milk before starting therapy. With a little patience, the baby will get used to the breast again after the breastfeeding break.

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

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