Many medications are safe for nursing moms

The Pediatric Insider

© 2016 Roy Benaroch, MD

An exhaustive new review should provide reassurance for nursing moms: many medications are safe for you to take, and genuinely serious reactions are very rare. Moreover, most serious reactions that do occur are to just a handful of medications. Common sense can be a good guide to keeping nursing babies safe when their moms take medication.

In this study, from February 2016, the authors did a truly comprehensive search of the literature for all studies and case reports of problems caused by medications in breast milk. The same authors had done a similar study in 2002, and decided it was time for an update.

Some of the findings:

  • About 60% of reported reactions occurred during the first month of life; and 80% during the first two months. This makes sense—the youngest babies consume the most milk per weight, and also have the least ability to metabolize medications.
  • 70% of adverse reactions were to medications that affect the brain, including narcotic pain medicines, antidepressants, and antipsychotic medications.
  • All of the deaths reported (there were only 2) involved one or more narcotic pain medications.
  • The use of multiple nervous system depressants at the same time increased the risk of serious reactions.

The bottom line: be careful especially with the youngest babies, especially when using multiple medicines, and especially when using medicines like narcotics that are known to cause slow and shallow breathing. That doesn’t mean nursing moms can’t take these medicine, but it does mean that they ought to take advantage of non-narcotic pain medicines, first, and if they do take narcotics their babies need to be monitored closely. A “pump and dump” strategy can be employed if mom needs potent pain medicines for a short time. It is not reasonable to expect nursing moms to live with untreated pain.

A great resource for nursing moms and the doctors who give them advice is the Lactmed database from the National Institutes of Health. You can look up just about any medication there, and see what studies are available to give you real and reliable information on milk transfer and potential issues with nursing babies. Some of the information is quite technical, but it’s better than the vague handwaving found in other places.

Speaking of which: one of the worst places to look for safety info for breastfeeding moms are the official “product inserts” of medications. They pretty much always say that nursing moms can never take any medicine (I don’t think they’re allowed to eat any food, either. Just water and rocks. Safety first!) Remember: product inserts are written by lawyers, for lawyers. They’re there to fulfill the crazy byzantine regulatory framework of the FDA. And to ward off lawsuits, and possibly vampires too. They’re not there to give parents or doctors useful information.

The health of moms is important, too. Often, moms stop taking their own medications out of fear that it may harm their nursing baby. Reviews like this, looking at what’s actually published and documented, provide some useful reassurance for moms and babies alike.

Wet nurse

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