How to Manage Medication While Breastfeeding: Continuing Breastfeeding with Peace of Mind
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Hello. As a pharmacist, I receive many consultations from breastfeeding mothers asking, "Is it okay to breastfeed if I take medication?"
"I have a terrible headache, but I'm worried it might affect my breast milk..." "I caught a cold, but do I have to stop breastfeeding if I take medicine?" "I want to restart my medication for a chronic condition, but do I have to give up breastfeeding?"
It is natural to hesitate to take medication when you are thinking about your baby. However, if you push yourself too hard and your health suffers, it will also affect your ability to care for your child.
In this article, I will provide you with the correct knowledge so that you can manage medication with peace of mind while breastfeeding.
Medication while breastfeeding: Basic concepts
Most medications are safe to use while breastfeeding
The first thing I want you to know is that many medications can be used while breastfeeding.
Many people believe that you should not take any medication while breastfeeding, but in reality, most medications pass into breast milk in very small amounts and have almost no effect on the baby.
The amount that passes into breast milk is minimal
When you take medication, the amount that passes into breast milk is usually only about 1-2% of the dose you took.
Furthermore, the amount the baby actually consumes from breast milk is usually only about 0.1-1% of the dose you took.
Medications that require stopping breastfeeding are limited
In fact, there are very few medications that require you to stop breastfeeding completely. In most cases, if you choose the right medication, you can continue treatment while breastfeeding.
Medications that are relatively safe to use while breastfeeding
Pain relievers and fever reducers
Acetaminophen (Calonal, Tylenol A, etc.)
This is considered the safest pain reliever and fever reducer for use while breastfeeding. It can be used with peace of mind for headaches, toothaches, and fevers.
Ibuprofen (Brufen, Eve, etc.)
While it could not be used in the late stages of pregnancy, it is relatively safe to use while breastfeeding. The amount that passes into breast milk is extremely low, and short-term use is not a problem.
Caution Required
Loxoprofen (Loxonin, Loxonin S, etc.): Data is limited, but many experts agree that short-term or occasional use is acceptable. Please consult your doctor or pharmacist.
Aspirin (Bufferin A, etc.): High-dose or long-term use should be avoided. For fever or pain relief, choose acetaminophen or ibuprofen.
Cold Medicine
Use single-ingredient medications rather than multi-symptom cold medicines
If you have cold symptoms, it is safer to use single-ingredient medications tailored to your specific symptoms (e.g., only a fever reducer or only a cough suppressant) rather than multi-symptom cold medicines.
Relatively safe ingredients
Fever reducer: Acetaminophen
Cough suppressant: Dextromethorphan (Medicon, etc.)
Expectorant: Carbocisteine (Mucodyne, etc.)
Rhinitis medication: Chlorpheniramine (Polaramine, etc.)
When purchasing over-the-counter medication, always inform the pharmacist that you are breastfeeding and ask for their advice.
Antibiotics
Relatively safe antibiotics
Penicillins (Amoxicillin: Sawacillin, etc.)
Cephalosporins (Cefcapene: Flomox, etc.)
Macrolides (Azithromycin: Zithromax, etc.)
These have low transfer rates into breast milk and can be used relatively safely while breastfeeding.
Points to note
Rarely, symptoms such as diarrhea or rashes may occur in the baby. If you notice any changes in your baby's condition, please consult a pediatrician.
Stomach medicine
H2 blockers: Famotidine (Gaster, Gaster 10, etc.) Antacids: Magnesium or aluminum preparations Gastric mucosal protective agents: Rebamipide (Mucosta, etc.)
These can be used relatively safely even while breastfeeding.
Laxatives
Magnesium oxide (Magmitt, 3A Magnesia, etc.): Safest Lactulose (Monilac, etc.): Highly safe
Stimulant laxatives (senna, bisacodyl, etc.): Avoid if possible, as they may cause diarrhea in the baby.
Anti-allergy medication
Relatively safe
Loratadine (Claritin, Claritin EX, etc.)
Cetirizine (Zyrtec, Stonarini Z, etc.)
Fexofenadine (Allegra, Allegra FX, etc.)
These second-generation antihistamines have low transfer into breast milk and are easy to use while breastfeeding.
Points to note
First-generation antihistamines (chlorpheniramine, etc.) may cause drowsiness in the baby, so long-term use should be avoided.
Topical medications
Topical steroids, moisturizers, antifungal creams, etc.
Medications applied to the skin have almost no systemic absorption, so they can be used safely while breastfeeding.
Use on nipples and areolas
If you apply medication to your nipples or areolas just before breastfeeding, please wipe or wash it off thoroughly before nursing.
Kampo (herbal) medicine
Relatively safe options
Kakkonto: For early cold symptoms
Shakuyakukanzoto: For muscle cramps
Tokishakuyakusan: For cold sensitivity and swelling
Kampo (herbal) medicines are not "safe just because they are natural." Please consult with a doctor or pharmacist before use.
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Medications that require caution or should be avoided while breastfeeding
Anti-cancer drugs and immunosuppressants
Breastfeeding prohibited
If you are using anti-cancer drugs or immunosuppressants, you must stop breastfeeding.
Radiopharmaceuticals
Temporary interruption of breastfeeding required
If radioactive substances such as radioactive iodine have been used for tests or treatment, you must interrupt breastfeeding for a certain period (several days to several weeks).
During this period, you should express milk regularly and discard it; you can resume breastfeeding once the period has passed.
Certain psychiatric medications
Lithium preparations: A treatment for bipolar disorder. Because it transfers into breast milk in significant amounts and there are concerns about its effect on the baby, it should be avoided while breastfeeding, or you should consult with your doctor to consider alternative medications.
Antidepressants and anti-anxiety drugs: Many can be used while breastfeeding, but safety varies depending on the specific drug. Please consult with your attending physician to select a medication that is safe for breastfeeding.
Stopping medication on your own judgment may cause your mental health to deteriorate, so please be sure to consult with your doctor.
Hormonal agents (some)
Estrogen-containing oral contraceptives (the pill): May reduce breast milk production.
For contraception while breastfeeding, consider the mini-pill (progesterone only) or other contraceptive methods.
Amiodarone (antiarrhythmic drug)
Avoid while breastfeeding, as it passes into breast milk in significant amounts and may affect the baby's thyroid function.
Ergotamine (migraine medication)
Avoid while breastfeeding, as it may suppress breast milk production and there are concerns about its effects on the baby.
For migraine treatment, use acetaminophen or ibuprofen.
Guidance on expressing milk when stopping or interrupting breastfeeding
When temporarily interrupting breastfeeding
When interrupting breastfeeding due to the use of radiopharmaceuticals or short-term medication, regular expression is necessary to maintain breast milk production.
Frequency and timing of expression
Express milk at the same frequency as breastfeeding (about 8–12 times a day, every 3 hours)
Express milk 1–2 times at night as well (important for maintaining milk production)
Discard the expressed milk while the medication is still in your system
Expression method
Use hand expression or a breast pump
Each expression session should last about 10–15 minutes per side
Express from both breasts
Points to note
If you neglect to express milk, your breast milk supply will decrease.
Regular expression is also important for preventing mastitis.
Please consult your doctor or pharmacist regarding when you can resume breastfeeding.
Timing of Medication and Breastfeeding
It is best to take medication immediately after breastfeeding.
It takes about 1 to 2 hours for the concentration of the medication in your blood to peak after taking it.
If you take the medication immediately after breastfeeding, the blood concentration will have decreased by the time of the next feeding (3 to 4 hours later), minimizing the amount transferred to the breast milk.
For long-acting medications
For once-daily medications or long-acting drugs, there is almost no need to worry about the timing.
This is because the amount of medication is trace and has almost no effect on the baby.
If you are worried
If you are still concerned, you can express milk before taking the medication and use that expressed milk for the next feeding.
However, this is unnecessary for most medications.
Observe your baby's condition
While taking medication, please observe your baby's condition more carefully than usual.
Consult a pediatrician if you notice these symptoms
Sleeping deeper than usual and difficult to wake up
Weak sucking strength or decreased milk intake
Diarrhea or vomiting
Rash
Rapid or labored breathing
If you observe these symptoms, please visit a pediatrician and inform them that "the mother is taking [medication name]."
Providing Information at Medical Institutions
Always inform them that you are breastfeeding
When visiting a medical institution or receiving medication at a pharmacy, please be sure to inform them that you are breastfeeding.
They can help you choose medications that are safe to take while breastfeeding.
Regarding Package Insert Information
Even if a medication's package insert states "do not administer while breastfeeding" or "avoid breastfeeding," there are many medications that can actually be used while breastfeeding.
This is often because pharmaceutical companies include such statements to avoid risk.
Do not judge based solely on the package insert; please consult with your doctor or pharmacist.
For Healthcare Professionals: Sources of Information on Medication During Breastfeeding and Differences in Evaluation (Also useful for the general public)
Why package inserts are insufficient
When evaluating medications during breastfeeding, it is necessary to understand that information in package inserts is often insufficient and deviates from actual clinical practice below, we explain the materials that should be used as references.
Many package inserts contain statements such as the following:
"It is desirable not to administer to breastfeeding women"
"Avoid breastfeeding"
"Consider the therapeutic benefits and the benefits of breastfeeding, and decide whether to continue or discontinue breastfeeding"
These are risk-avoidance statements by pharmaceutical companies and are often not based on actual scientific evidence.
Specific Example: Differences in the Evaluation of Levofloxacin (Cravit)
Levofloxacin, a fluoroquinolone antibiotic, is a typical example where evaluations vary significantly across different information sources.
1. Evaluation in the package insert "It is desirable not to administer to breastfeeding women, but if administration is unavoidable, breastfeeding should be avoided."
→ A statement that gives the impression of prohibiting breastfeeding
2. Evaluation by the National Center for Child Health and Development's 'Medication Information for Moms' "Probably safe"
Minimal transfer into breast milk
Breastfeeding is possible with short-term use
→ An evaluation that breastfeeding can be continued
3. Hale's Lactation Risk Category L2 (Probably safe)
Minimal transfer into breast milk
No reports of adverse events in infants
No issues with short-term use (about 5 to 10 days)
→ An evaluation that it should be used with caution but breastfeeding is possible
4. Evaluation by LactMed (U.S. National Library of Medicine)
Breast milk concentration is about 50-75% of maternal serum concentration
The amount ingested by the infant is about 3-5% of the maternal dose
With short-term use, the impact on breastfeeding is minimal
However, long-term or repeated use should be avoided
Be aware of potential infant diarrhea or effects on intestinal flora
→ An evaluation that breastfeeding is possible with short-term use, but caution is required
What we can learn from the differences in evaluation
As shown, the evaluation of the same medication can vary significantly depending on the source of information.
Package insert: Most conservative (often states that breastfeeding is prohibited) National Center for Child Health and Development, Hale, LactMed: Evaluates that breastfeeding is possible in most cases based on evidence.
In other words, if you decide that you cannot breastfeed based solely on the package insert, you may unnecessarily discontinue breastfeeding.
More practical information sources
Healthcare professionals need to make comprehensive judgments by using not only package inserts but also the following information sources.
1. National Center for Child Health and Development 'Medication Information for Moms'
Available in Japanese
Information based on scientific evidence
Available to the general public
2. LactMed (Drugs and Lactation Database)
Operated by the U.S. National Library of Medicine
The most comprehensive and detailed database
Available for free
Evidence levels are clearly stated
3. Medications and Mothers' Milk (Hale's Lactation Risk Categories)
Lactation risk classification by Dr. Thomas Hale
-
Medications classified into 5 levels:
L1: Safest (studied in many breastfeeding mothers with no issues)
L2: Relatively safe (no issues in limited studies)
L3: Probably safe (potential risk exists but is low)
L4: Probably dangerous (evidence of risk exists)
L5: Contraindicated (clearly dangerous)
Practical and easy-to-use classification
4. e-lactancia (database by a Spanish pediatric hospital)
Visually easy to understand (color-coded)
Also offers suggestions for alternative medications
Available for free
5. Book "Breastfeeding and Medication" (Katsumi Mizuno et al.)
A practical book in Japanese
Includes specific cases and response methods
Key points for comprehensive judgment
When determining the use of medication while breastfeeding:
Consult multiple sources of information(do not rely solely on package inserts)
Check the amount transferred to breast milk(M/P ratio, Relative Infant Dose (RID), etc.)
Prioritize maternal health as well(there are cases where treatment should take precedence)
Consider the benefits of continuing breastfeeding(do not stop breastfeeding unnecessarily)
Examine the availability of alternative medications(switch if a safer medication is available)
Collaborate with specialists(obstetricians, pediatricians, pharmacists)
Key points for explaining to patients
"Although the package insert states that breastfeeding should be avoided, the actual amount transferred to breast milk is minimal, and you can continue breastfeeding if the medication is used for a short period."
By providing evidence-based explanations in this way, you can avoid unnecessary cessation of breastfeeding.
Conclusion: Don't give up on breastfeeding
Many people believe that if they take medication, they must give up breastfeeding, but in most cases, you can continue to breastfeed while taking medication.
If the mother is not healthy, she cannot take care of her baby.
Do not endure too much; use medication when necessary, and continue breastfeeding.
If you are anxious, please do not hesitate to consult your doctor or pharmacist.
Wishing you and your baby a healthy and happy breastfeeding period.
[Reference]
National Center for Child Health and Development: "Medication Information for Moms"
LactMed (Drugs and Lactation Database, National Library of Medicine)
Thomas W. Hale: "Medications and Mothers' Milk"
Japan Society of Obstetrics and Gynecology / Japan Association of Obstetricians and Gynecologists: "Obstetrics and Gynecology Clinical Practice Guidelines"
Katsumi Mizuno et al., "Breast Milk and Medicine"
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