Medications: what's safe while pregnant and breastfeeding

Many medicines are safe for pregnant and breastfeeding mothers and their babies. But some are safer than others. So when you’re pregnant or breastfeeding, you’ll want to check with your health care provider before you take any medicine, including over-the-counter drugs and dietary and herbal products.

It’s important to balance the possible risks and benefits of any medication being considered. Suddenly stopping the use of a medication may be riskier than continuing to use the medication while under a doctor’s care, notes the Centers for Disease Control and Prevention (CDC).

Medications and pregnancy

Certain medications during pregnancy can cause serious birth defects, says the CDC. Examples are thalidomide (also known as Thalomid®) and isotretinoin (also known as Accutane® or Claravis®). Such medications should be avoided by all women who are or might become pregnant. For women who are taking these medications, it’s important to discuss effective contraception methods with their doctor.

But some pregnant women must take other medications to treat health conditions. For example, if a woman has asthma, epilepsy, high blood pressure, or depression, she might need to continue to take medication to stay healthy during pregnancy. If these conditions aren’t treated, a pregnant woman or her unborn baby could be harmed. 

Medications and breastfeeding

Most medications are compatible with breastfeeding and rarely reach a clinically relevant dose for the infant, according to the Arizona Department of Health Services. While most drugs do pass into your milk, most appear in only low levels and post no real risk to infants, notes the Mayo Clinic. So temporary weaning is often unnecessary.

Here are some other tips on medications and breastfeeding from La Leche League International, the Mayo Clinic, and the Los Angeles County Department of Public Health. These should be discussed with your health care provider, who can assess what’s appropriate for you and your baby:

  • Check with your health care provider about the time of day to take medication. In general, try to take it 2 hours before breastfeeding to allow it time to pass through your body. Or wait until right after you breastfeed.
  • Choose medications that are less likely to cause drowsiness. It’s important that your baby stay awake while breastfeeding.
  • Watch your baby for unusual signs or symptoms. These include changes in eating or sleeping habits, fussiness, or a rash. If you notice any change, contact your health care provider.
  • Avoid taking medications that aren’t necessary. These include herbal medications, high-dose vitamins, and unusual supplements.
  • If the doctor prescribing the medication advises you to wean, have them consult your baby’s doctor to ensure that weaning is necessary.
  • If you have advance notice that you’ll be taking a medication and your health care provider recommends not breastfeeding while taking it, use a breast pump to produce additional milk in addition to breastfeeding before starting the medication. Store the surplus expressed milk for use when you stop taking the medication.
  • If you need to stop breastfeeding only temporarily, use a double electric breast pump to maintain your milk supply until you’re able to breastfeed again. Discard the milk you pump while you’re taking the medication.
  • In the unlikely event that you need to stop breastfeeding permanently, ask your health care provider for information on weaning and for help in choosing an infant formula that will meet your baby’s needs.

Note that in April 2017, the U.S. Food and Drug Administration (FDA) issued a strengthened warning to mothers that breastfeeding is not recommended when taking codeine or tramadol medicines.

Sources of more information about medications

If your health care provider is uncertain or you want to double-check on whether a medicine is safe, here are several trusted resources:

  • The InfantRisk Center hotline is a resource for parents and health care providers who have questions about the use of medication during pregnancy or breastfeeding. The staff respond to questions by phone free of charge at (806) 352-2519 on weekdays during business hours. 

  • LactMed database is a source for information about medications and herbs and is sponsored by the U.S. National Library of Medicine.
  • MotherToBaby, a service of the nonprofit Organization of Teratology Information Specialists (OTIS), provides a wealth of information for pregnant and breastfeeding women on a wide range of topics, including medications, herbal products, substances (alcohol, marijuana, etc.), and more. OTIS also provides a toll-free hotline at (866) 626-6847 and is available by text at (855) 999-3525.
  • The Office of Women’s Health (OWH) page on pregnancy and medicines provides information useful in deciding whether to use medication while pregnant. Also, the OWH Helpline is available at (800) 994-9662 during normal business hours.
  • Medications and Mother’s Milk provides information on the safety of medications for breastfeeding mothers. Although the book is aimed at an audience with a background in the health sciences (such as physicians, pharmacists, and midwives), many breastfeeding support counselors keep a copy in their libraries.

Last updated February 5, 2018

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