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| Education and Support for Nursing Mothers |
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| What Should You Know about Taking Medications when Nursing? |
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| Taking Medication when Nursing |
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| Last Updated February 2, 2004 |
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| Most medications will get into the breastmilk to some degree, but in most cases, the amount that gets to your milk is relatively small. |
| Pharmaceutical manufacturers often put warning labels that discourage breastfeeding while using the medication due to fear of getting sued, not because they've done actual studies showing this medication to be harmful to the baby or to the mother's supply. The PDR (Physician's Desk Reference) lists only the package insert for the drug and is therefore a very poor source of accurate information about a drug's safety for a nursing mother. |
| The amount of a drug that is excreted into a mother's milk depends on several factors, according to Dr. Thomas Hale's lactation pharmacology book, "Medications and Mothers' Milk:": |
| The level of the drug in the mother's bloodstream; How soluble the drug is in lipids (fats) and the fat content of the milk; The pH of the milk; The molecular size of the drug; Protein binding of the drug in the mother's plasma; The maternal half-life of the drug; The molecular weight of the drug. |
| Dr. Hale lists the following considerations for health care providers for the use of drugs during breastfeeding: |
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| Avoid using medications where possible; When needed, evaluate the infant dose and perform individual risk xxxassessment; For many drugs, a relative infant dose of less than 10% is xxxconsidered safe; Preferred drugs are those for which we have breastfeeding data; Avoid the peak, feed toward the end of the dose to reduce the xxxexposure of the infant; Discontinuing breastfeeding for some hours/days may be required, xxxparticularly with radioactive compounds; Choose drugs with short half-lives, high protein binding, low oral xxxbioavailability, or high molecular weight; Be more cautious with preterm or low birth weight infants; Many drugs are safe in breastfeeding mothers and the benefits of xxxbreastfeeding often outweight the risks to the infant's well-being; Drugs that alter milk production may be riskier during the neonatal period than later; Drugs approved for use in pediatric patients are generally safe for the mother to take; Premature and newborn infants are at greater risk than older babies. |
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| This Page What should you know about taking medications when nursing? What do the "Lactation Risk" categories mean? |
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| What do the "Lactation Risk" Categories Mean? |
| Dr. Hale's "Lactation Risk" categories range from L1 ("safest") through L5 ("contraindicated"). Specifically: |
| 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. |
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| 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. |
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| 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. |
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| L4 Possibly Hazardous: There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits from 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). |
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| 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 outweights any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant. |
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| How this listing is organized; Other sources for checking information; Med. Listing Partial listing of: Analgesics; Anesthesthetics; Antacids & Related Medications; Acne - Topical Treatments |
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| Med. Listing Partial listing of: Antihistimines; Antimigraine; Asthma meds, bronchodilators, Intrapulmonary steroids; Antivirals; Nasal steroids; Non-steroidal nasal sprays; contraceptives |
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| Med. Listing Partial listing of: Decongestants; Expectorants; Diabetes meds; Diuretics; Cholesterol meds; Cough suppressants; Corticosteroids; Laxatives |
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| Med. Listing Partial listing of: Antidiarrheals; Antiemetics & Antinauseants; Antihypertensives; Antifungals; Antipsychotics |
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