MEDICATIONS AND BREASTFEEDING PROBLEMS

 

Concern about potential harm to the nursing infant from maternal medications is often cited as a reason to advise discontinuation of breastfeeding.

Transfer of Medications into Breast  Milk

The drug concentration in breast milk is largely determined by the maternal serum drug concentration. The safety of a medication during pregnancy does not necessarily imply safety during breastfeeding because the nursing infant must independently metabolize and excrete the medication. Medications and Mothers' Milk can be especially useful in the office setting because it is inexpensive, is updated annually and details theoretic and documented effects of maternal medications on the breastfeeding infant.

 

Allergic Rhinitis Captopril (Capoten) and enalapril (Vasotec) are excreted into breast milk in small amounts.

 

Diabetes Based on studies of the distribution of first-generation sulfonylureas into breast milk, the AAP considers tolbutamide (Orinase) to be compatible with breastfeeding.

Specific Categories of Medications

Tetracycline is excreted in small amounts in breast milk, but the calcium in breast milk limits its absorption. Colic and fussiness have been attributed to elevated serum concentrations of fluoxetine and its metabolite in nursing infants. Epidural use of bupivacaine (Marcaine), lidocaine (Xylocaine), morphine, fentanyl (Sublimaze) and sufentanil (Sufenta) is generally safe in breastfeeding mothers. Morphine, codeine and hydrocodone are considered compatible with breastfeeding by the AAP.

 

Contraceptive Agents Hormones contained in combination oral contraceptive pills (OCPs) are not harmful to infants but, because estrogen diminishes the maternal milk supply, these products should be avoided in breastfeeding mothers whenever possible, especially during the first two months of breastfeeding.

Anesthetic Agents

In general, the healthy term infant can safely nurse as soon after surgery as the mother is awake and alert.

 

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