Drugs Log

Just as when they were pregnant, breast-feeding moms need to monitor the drugs they take, which could reach their infants.

The American Academy of Family Physicians offers these medication guidelines for breast-feeding mothers:

1. If you must take medications orally, take them just after breast-feeding, to give the medications time to travel through your system.
2. Generally, acetaminophen and NSAIDs are safe pain relievers for nursing women, but always check first with your doctor.
3. Don’t take aspirin while breast-feeding, as it may lead to bleeding and skin rash in babies.
4. Don’t take antihistamines long-term while breast-feeding.
5. Carefully monitor your baby for any side effects from your medications. Be especially aware of symptoms such as trouble breathing or skin rash.

TAKING MEDICATIONS SAFELY WHILE BREASTFEEDING

Most drugs that go into your body will also go into your milk, so before you take any medication, you need to consider how it will affect your baby and whether or not it has any effects on lactation. While most medications are safe to take while breastfeeding, it’s wise to talk to your doctor or your baby’s doctor before taking anything. Here are some general guidelines.

There are three issues to consider when considering taking medication while breastfeeding:

Do you need the drug?

Will the drug affect baby?

Will the drug affect your ability to make milk?

Answering these questions should help you weigh the risks and the benefits of taking a particular medication. As you gather information about the medication, you may also want to consider whether timing the dosage can minimize baby’s exposure to the drug. If it’s absolutely necessary to avoid breastfeeding while taking a medication, consider temporary weaning pump and dump as an alternative to stopping breastfeeding entirely.

Do you need the drug? How sick are you? Be honest. Trying to tough it out for several days may actually decrease your milk supply, and you may not be a very good mother to your baby during this time. Taking medicine may often lessen the severity and duration of your illness, and in some situations, it’s absolutely necessary. If the medication is necessary for your own well-being, usually the benefits to you–and indirectly, to baby–will outweigh the risks of baby being exposed to a small amount of the medication in your milk. (There are exceptions to this. See the drug chart for information on medications that should not be taken by breastfeeding mothers.)
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On the other hand, if you have a minor ailment, such as a cold, consider alternatives to taking medicine. While nearly all over-the-counter cold remedies are safe to take while breastfeeding, many are only marginally effective. You may get more relief by treating your cold the old- fashioned way: steam, extra fluids, rest, and a tincture of time.

Another question to ask is do you need this drug? Often, if a particular drug is not safe to take while breastfeeding, or if little information is available about a drug, you and your physician may decide to treat your condition with another medication that is known to be safe. If there are several different drugs that can be used to treat your illness effectively, the doctor should choose the one least likely to affect your baby and your milk production. This may mean using older drugs rather than the latest thing from the pharmaceutical company.

If your doctor thinks it is necessary for you to wean because of a drug or a particular medical procedure, ask do you need this drug now? Perhaps you can safely delay the treatment until your baby is older or weaned. Drugs in breastmilk present less of a problem to an older breastfed baby. Yet if you’re planning to nurse until your baby weans herself, the day when you will no longer be breastfeeding may be a lot further off than either you or your doctor anticipate.

Will the drug affect baby?

Many drugs taken by a mother make their way into her milk. The important question is not whether the drug gets into milk, but whether the levels in the milk are such that they will affect the baby.

Here are some of the factors that influence how much of a drug gets into a mother’s milk and how it affects her baby.

While most drugs do pass into your milk, most appear in only minute amounts - usually around one percent or less of the amount taken by the mother.

The route of administration influences how fast the medication enters and clears from your blood, and therefore your milk. For example, some medications come in both oral and inhalant forms, which have different clearing times.

It’s better to use a short-acting medicine that is taken three or four times a day than to use a long-acting, once-a-day form of the medication. . Although less convenient, short-acting medications clear from your blood and milk faster. They’re also easier for babies to metabolize, so there is less risk of the drug accumulating in the infant’s system.

Consider the age of your baby. More caution is called for when giving medication to a mother who is breastfeeding a premature or newborn infant ten times a day than when prescribing medication for a woman breastfeeding a one-year-old four times a day. An infant that feeds more frequently naturally gets more of the medicine, and the smaller size of the younger infant means the drug will be more concentrated in the baby’s body. . Also, the liver and the kidneys of older infants are better able to metabolize and eliminate the drug.

Most drugs taken by the mother are of less concern while breastfeeding than if she were taking them during pregnancy. If a drug is safe to use during pregnancy, it is probably safe during lactation. There is more reason to be concerned about the effects of a drug on a growing fetus than on a fully developed infant.

If there are concerns about possible effects on your baby, can the doctor monitor the baby during the time you are taking the drug? This might involve checking levels of the drug in your milk or the baby’s blood, or watching carefully for changes in your baby’s behavior.

Be particularly cautious about taking more than one drug while breastfeeding. While each drug taken separately may be listed in the safe category, together they may be unsafe (if not for your baby, for you). Be sure to tell your doctor about any medications you are already taking before he prescribes another. Pharmacists are often the most reliable source of information on drug interactions.