Medication While Breastfeeding

From Kelly Mom

Breastfeeding Risks:

All medications are broken down into 5 levels of safety for use while breastfeeding.

L1

SAFEST: Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

L2

SAFER: Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3

MODERATELY SAFE: There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4

POSSIBLY HAZARDOUS: There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5

CONTRAINDICATED: Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Help Lines and Websites:

You can look up the safety of a medication and it's effects on lactation and the breastfed infant at LacMed Search.

Breastfeeding and Human Lactation Study Center, based in NY, USA, maintains a database that is provides free information to physicians and lactation consultants on uses of medication and their effects during breastfeeding. You can visit their website here.

Motherisk, based out of Ontario, Canada, has evidence-based information about the safety of drugs, chemicals, and diseases while pregnant and breastfeeding. You can call, 416-813-6780) or visit their website.

Drugline, based out of Paisley, Scotland, is a call line that provides information on prescription drugs while breastfeeding. Their website can be found here.

Kelly Mom also has lots of information about various types of drugs, for both during pregnancy and while breastfeeding. Including this list that breaks down the common concerns.

Most WIC offices also carry a book that contains medications and their risk level. Just contact your local office and ask to speak with their breastfeeding peer counselor.

Safe Prescriptions:

For quick reference, all medications listed below are L1 or L2.

*These are their trade names, if you are unsure if your medication goes by another name you can type it into Google and search for “Trade name” to find out.

Pain Relievers: Tylenol, Advil, Nuprin, Motrin, Pediaaprofin, Rheumox, Toradol, Acular, Feldene, Sublimaze, Darvocet N, Propacet, and Darvon. Demerol is L2 unless used early postpartum then it is a L3.

Anesthetics: Fluothane and Xylocaine

GI Meds: Motilum, Propulsid, and Tagamet

Antibiotics: Larotid, Amoxil, Azactam, Ultracef, Duricef, Ancef, Kefzol, Claforan, Mefoxin, Cefzil, Ceftazidime, Fortax, Taxidime, Rocephin, Garamycin, Kebecil, Kantrex, Macrobid, Floxin, Penicillin, Gantrisin, Azo- Gantrisin, Achromycin, Sumycin, Terramycin, Ticarcillin, Ticar, and Timentin.

E-Mycin, Ery-tab, ERYC, and Ilosone are all L1 unless taken early postnatal then they are L3.

Anticoagulants: Coumadin and Panwarfin

Anticonvulsants: Tegretol, Epitol, Epsom Salt, Dilantin, Depakene, and Depakote

Antifungals: Diflucan, Nizoral Shampoo, and Nizoral

Antihistamines: Allegra, Claritin, Actidil, and Actifed

Antivirals: Zovirax, Alferon N, and Interferon Alpha

Asthma Meds: Bricanyl and Brethine

Birth Control: Enovid

Provera, Depo-Provera, Cycrin are all L1 unless used in the first 3 days postpartum then they are L4.

Diarrhea Meds: Imodium, Pepto Diarrhea Control, Maalox Antidiarrhea Caplets, Kaopectate II Caplets, and Immodium Advanced

** Note: Pepto-Bismol & Kaopectate (bismuth subsalicylate is the active ingredient in both) are not recommended for routine use by nursing moms, due to the association of salicylates with Reyes syndrome in children 

Diuretics: Dazamide, Diamox and Aldactone 

Galactagogues (milk supply): Motilum

Heart, Blood Pressure Meds-

Antiarrhythmics: Norpace, Napamide, Mexitil, Quinaglute, and Quinidex

Antihypertensives: Vastoec, Apresoline, Trandate, Normodyne, Aldomet, Adalat, Procardia, Inderol, Blocadren, Calan, Isoptin, and Covera-HS.

Loniten, Mindodyl, and Rogaine are L2 when used topically. If taken orally they are L3.

Cardiac Stimulants: Lanoxin and Lanoxicaps 

Laxatives: Epsom salt

Malaria Meds: Plaquenil and Quinamm 

Medical Testing: Isopaque, Amipaque, Telepaque, and Omnipaque.

Gadopentetic (Gadolinium), generic name, is also a L2.

Steroids: Solu-Medrol, Depo-Medrol, Medrol, Deltasone, Meticorten, and Orasone.

Prednisolone, generic name, is also a L2.

Thyroid Meds: PTU, Synthroid, Levothroid, Thyroid, Levo-T, and Levoxyl 

Tuberculosis Meds: Ethambutol, Rifadin, and Rimactane 

Vitamins: B-12, Folic Acid, K-1, and Riboflavin/B-2.

B-6 is an L2, unless taken in high doses, which may inhibit lactation, and then it is a L4.

Miscellaneous: Zyloprim, Lopurin, Rheumox, Lioresal, Atrofen, Vivarin, NoDoz, Plaquenil, Mestinon, and Regonol