Medications

Choosing Medications

• Choose a medication that will not affect the breastfeeding infant or the mother’s milk supply.
• Use caution with medications in newborns and young infants. As the infant grows, she can tolerate and eliminate small amounts of drugs. Older infants (ages 4-18 months) can tolerate medications much better than newborns.
• Choose a medication that has high-protein binding at 90-99 percent. Such medications are more often held in the mother’s bloodstream and do not readily transfer to the breastmilk and the baby.
• Ointments to treat the nipple (e.g. vitamin E oil, essential oils) are likely to be absorbed by the infant. Use only minimal amounts and encourage mother to rinse it off before feeding.
• Most prescription antifungal or antibacterial creams to treat the nipple can be blotted off prior to the next feeding. Typically, the infant’s absorption from these topical products is low. Avoid scrubbing the nipples as this causes additional trauma.
• When using Hale’s Medication and Mother’s Milk™ as the medication reference guide: note that medications that have an L1 to L3 rating are generally preferred. Avoid drugs with L4 and L5 ratings.

Patient Instructions

• For medications with a short half-life (the time it takes to clear ½ of the medication from the mother’s bloodstream), tell mothers to breastfeed first, then take their medication(s). Generally, the next time she feeds, the plasma level of the drug will be lower. Make sure to check the peaking time (Tmax) to minimize peaking during the next feeding. Share with mother the preferred medication time recommendation.
• For medications with a long half-life, timing of the medication relative to breastfeeding is less important. Often these are medications that are only taken once daily.
• With radiological contrast agents (those used for imaging studies), check the specific contrast agent. The American College of Radiology provides suggestions and many agents are compatible with continued breastfeeding.
• With radioactive compounds (not radiological contrast agents) and dangerous medications, contact the InfantRisk Center of Texas Tech University:
  • Have the mother wait to breastfeed until the medication has cleared her system. (This is generally five times the half-life (T ½) of the drug.)
  • Instruct the mother to pump and throw away her milk in order to maintain her milk supply while she is waiting for her system to clear from the medication.
  • If there is ample time before a procedure, encourage her to pump and store her milk so that she can give it to her baby while the radioactive compounds or dangerous medications are still in her system.
  • Detailed information about the activities of radiopharmaceuticals is available at InfantRisk.org.

Clinical Guidelines

• Mitchell, K. B., Fleming, M. M., Anderson, P. O., Giesbrandt, J. G., & Academy of Breastfeeding Medicine (2019). ABM Clinical Protocol #31: Radiology and Nuclear Medicine Studies in Lactating Women. Breastfeeding Medicine, 14(5), 290–294.
• Reece-Stremtan, S., Campos, M., Kokajko, L., & Academy of Breastfeeding Medicine (2017). ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeeding Medicine, 12(9), 500–506.
• Reece-Stremtan, S., & Marinelli, K. A. (2015). ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeeding Medicine, 10(3), 135–141.

References

1. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core Curriculum for Interdisciplinary Lactation Care. Jones & Bartlett Learning. 
2. Hale, T. W. (2019). Hale's Medications & Mothers' Milk, 2019: A Manual Of Lactational pharmacology (18th ed.). Springer Publishing Company. 
3. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A Guide for the Medical Profession (8th ed.). Elsevier.