More than forty percent of women in the United States of childbearing age (18-44) take at least one prescription per day. Even though prescription drugs help mothers lead healthier lives, they are detrimental to babies who do not share mother's illnesses.
Prescription drugs enter mother's bloodstream and become part of breast milk. During breastfeeding, prescription drugs should be avoided except where medically necessary. In those instances, consulting the prescribing obstetrician and the pharmacist is mandatory. Herbal supplements and over-the-counter medicines can have the same detrimental effects as prescription medicines.
1. Stay on prescribed medicines
Some medicines can not be stopped without risking harm to the mother. These include medicines that treat:
Epilepsy
High blood pressure
Seizures
Depression
Asthma
These medicines are needed during both pregnancy and breastfeeding, since the disease's effect is worse for the child than the medicine. Consult the obstetrician to choose the medicines that will cause no or the least harm to the infant.
2. Which medicine is safest?
~The safest drugs are those that are administered topically (through the skin). These will not usually transfer to breast milk.
~Medicine that is safe for the nursing baby is safe for the mother.
~Just because medicine was approved during pregnancy does not mean that use during breastfeeding is safe.
3. How are medicines chosen for breastfeeding mothers?
~Use reliable information from the obstetrician and the sources listed at the end of this article.
~Choose medicines that are well-studied in babies. These will have the most reliable and consistent information.
~Use medicines that are poorly absorbed orally. Stomach contents are the building blocks of breast milk.
~Choose medicines with a short half-life. These prescription drug will not build up and stay in the mother's system for a long period. This reduces the amount and chance that the drug will be passed to the nursing infant.
~High protein-binding ability will allow the medicine to transfer more readily to the mother.
~Low lipid solubility will keep the drug from binding to the major ingredients of breast milk.
4. When should medicine be taken?
~Prescriptions that are taken only once per day should be taken just before the baby's longest sleep interval. By breastfeeding the baby and emptying the breasts, the milk produced will contain less medicine and will be diluted by the most "clean" breast milk.
~Multiple dose medicines should be taken after nursing the baby. This allows the mother's body to use more medicine before distributing any to the breast milk.
5. Stop breastfeeding?
If the obstetrician advises, stop breastfeeding while taking certain prescriptions. The effect of the medicine on the infant can be fatal.
By feeding baby formula, pumping the breasts and discarding the milk, breastfeeding mothers can continue to breastfeed after a regimen of needed medication that is unsafe for baby.
6. Which prescription drugs should be avoided?
Antibiotics
Most antibiotics are transferred to breast milk in trace amounts. The most common antibiotic that should be avoided is trimethoprim-sulfamethoxazole (Bactrim, Septra) because it should not be used while nursing infants less that two months old. It can cause bilirubin to rise in the infant causing jaundice.
Other antibiotics that should not be taken are tetracycline, doxycycline (Vibramycin) or minocycline (Minocin) because they have high absorption by infants and children that cause toxic problems including dental staining and decreased bone growth.
Metronidazole (Flagyl) has not been recently studied, but older studies showed a link between it and mutagenicity (changing of baby's sex).
Less-studied drugs like quinolones, clotrimazole (Gyne-Lotrimin) and miconazole (Monistat) should be used when more well-studied prescriptions cannot be used and only after the benefits and risks are weighed by the mother and doctor.
Anti-depressants
Tricyclic antidepressants are commonly avoided despite research showing that infants receive very small amounts of the drugs. These are replaced with selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and paroxetine (Paxil), a very well-studied drug.
Fluoxetine (Prozac) has been associated with colic and fussiness.
Analgesics (pain relievers)
Repeated exposure to analgesics through breast milk can harm infants because their livers are not completely formed and able to process the drugs.
Naproxen (Naprosyn), piroxicam (Feldene) and sulindac (Clinoril) have long half-lives and should be taken with caution and only after exhausting other avenues of nonsteroidal anti-inflammatory drugs (NSAID) choices.
Meperidine (Demerol) should not be used by breastfeeding women.
Hypertensive treatment (high blood pressure medicines)
There are a significant number of approved prescriptions for hypertension and an equally high number of substitute medicines for them. The four that are not endorsed for breastfeeding mothers are atenolol (Tenormin), diltiazem (Cardizem CD), nadolol (Corgard) and sotalol (Betapace).
Diabetes treatment
Most diabetes medications are not transferred to breast milk. Two medicines are not recommended for nursing mothers: Thiazolinediones and Metformin (Glucophage).
Epilepsy
All of the most common drugs for seizure prevention or control are approved for use during nursing with the exception of phenobarbital. It is no longer prescribed for epilepsy or depression during pregnancy or breastfeeding.
Contraception (birth control)
The active ingredients in most birth control pills are estodiols, a semi-synthetic female hormone. Estrogen reduces or eliminates the amount of breast milk produced by the mother. Instead of common birth control pills, many doctors prescribe progestin-only pills or POP (MicroNor). POP may reduce milk production. Barrier or intrauterine (IUD) methods are preferred.
7. How is medicine approved?
Before the Food and Drug Administration (FDA) approves new prescription drugs, they are tested on animals in the laboratory to identify potential problems. Pregnant and nursing animals do not take part in the tests.
During trials, humans take the drug to identify side effects and the actual efficacy of the drug when used as prescribed. Pregnant and nursing women do not take part in these trials. Drug approval by the FDA does not include consumption during pregnancy or nursing.
Without testing on nursing women, a prescription drug approved for adults may not be safe during breastfeeding. The obstetrician will have clinical information and knowledge of the infant's developing systems, making for the best advice.
8. What about pregnant women and breastfeeding mothers?
Doctors will get information from four places. Adverse reaction reports are issued by the FDA when they receive information from the drug manufacturers and voluntary reports by doctors and citizens.
FDA pregnancy registries are available. Pregnant women who have taken certain prescription drugs can register their pregnancies. Their children are compared to children whose mothers did not take the prescription drugs. (http://www.fda.gov/womens/registries)
The Organization of Teratology Information Services (OTIS) will provide information to health care professionals and pregnant women on prescription drug use during pregnancy and breastfeeding. OTIS studies volunteer pregnant women. (http://www.otispregnancy.org)
The National Birth Defects Prevention Study and other scientific researchers study the effects of prescription medications on pregnant and nursing women and their children. Since all of these agencies are independent and are not linked, information is not complete.
Before taking any prescription drug while breastfeeding, talk to the prescribing doctor and the pharmacist. These professionals can give you written information, talk about possible complications and provide more resources for further research.