Specific Drugs and Their Effect on Breast Milk (Nursing)

by Rhonda Lawes

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    00:00 So let's look at some common categories of medications that lactating mothers take.

    00:05 Antibiotics are one of the most common medications that mothers are prescribed and all these pass in some degree into the milk.

    00:15 So in general, if an antibiotic would be administered directly to an infant or a neonate, then it's safe for the mother to take during breastfeeding.

    00:24 That's the general rule.

    00:25 So lactating moms, it's one of the most common meds to take are antibiotics.

    00:30 If it would generally be safe to give to the infant or the neonate, it's safe for the mom to take it while breastfeeding.

    00:38 Now we talked about med timing.

    00:40 For about once-a-day medications, if the patient is taking a medication just once a day and it's a possibility for the woman to take it at night, it would be great for them to take it immediately after a feeding when your baby will have the longest period without nursing.

    00:56 For a lot of women, that's at night and for once a day, that would work well.

    01:01 But another rule of thumb is immediately after a feeding, you wanna give your baby the biggest break, the longest period without nursing again.

    01:09 So I'm not saying don't feed your babies.

    01:12 Make sure you're really clear on that but you wanna give them medication after a feeding when you have the longest period of time before your baby will nurse again.

    01:21 If a once a day medication is appropriate, it's likely that patients will take that at nighttime because you're gonna have that time the baby is sleeping at night as a break.

    01:31 Antibiotics are common but look at acetaminophen.

    01:35 Most -- everyone knows what acetaminophen is whether you know it by that generic name or its brand name of Tylenol.

    01:42 Now, my problem with acetaminophen is I prefer -- for my aches and pains, I prefer ibuprofen or really, naproxen.

    01:50 However, that's not the best option for moms.

    01:53 So even though acetaminophen doesn't work as well for swelling, cramps, and muscle inflammation, it's a safer option.

    02:01 So we give acetaminophen to infants for fever and pain reliever so it's safer for the baby to get that in the breast milk.

    02:08 And again, the amounts in the breast milk are gonna be much less than the doses that we usually give to infants and adverse effects are really pretty rare with this.

    02:18 So acetaminophen is considered compatible with breastfeeding by the American Academy of Pediatrics.

    02:24 So this is always gonna be a safe medication for a lactating mom.

    02:29 Now here's the one I like for myself, naproxen, but I'm not breastfeeding so I can take it without any problems.

    02:36 You may know this by its brand name of Aleve. It's a longer-acting NSAID.

    02:41 Now, it's not recommended to avoid naproxen for lactating moms so let's slow down there and make sure you don't miss that.

    02:49 Circle that or underline it, avoid naproxen during breastfeeding because naproxen's long half-life which is why I like it for a non-lactating person, has a really long half-life and the potential for reaction in the breastfed neonate.

    03:05 That's why it's not recommended.

    03:07 So write yourself a quick note. Long half-life, that's one of the main reasons it's not recommended.

    03:12 Now the side effects of anemia, prolonged bleeding time, thrombocytopenia for low platelet counts were also reported in neonates so that's why naproxen is a no-go if you're breastfeeding.

    03:25 Now ibuprofen is another over the counter NSAID.

    03:29 You might know it as Motrin or Advil.

    03:31 Those are some of those brand names but they're used for headaches, back aches, and muscle soreness.

    03:37 Just the general NSAID usage.

    03:39 But ibuprofen is one of the preferred choices as an analgesic or anti-inflammatory drug for nursing mothers.

    03:46 Okay, so that's good news.

    03:48 Tylenol's a good choice, naproxen is out, ibuprofen is actually an option because ibuprofen has extremely low levels in breast milk.

    03:58 Now that's pretty cool. It's got a short half-life which is why if you're not breastfeeding, you may prefer the ones with the longer half-life but you can see why in breastfeeding, this is a much better deal.

    04:09 Ibuprofen has an extremely low level in breast milk, got a short half-life, and the level of ibuprofen excreted in breast milk is much lower than the recommended dosage for infants.

    04:20 So see why ibuprofen is a much better choice for breastfeeding moms than naproxen.

    04:26 Now, aspirin. You should just avoid in most causes.

    04:31 I'm gonna tell you why but naproxen is a no and aspirin is a no in most cases.

    04:37 Let me tell you about the exceptions.

    04:39 Now the risk of Reye's syndrome for salicylate in breast milk, we don't really know for sure what that is but we just recommend that you avoid high dose aspirin.

    04:47 An alternate pain reliever like acetaminophen or ibuprofen is a much better choice and is preferred for over the counter -- it's preferred over the counter high dose aspirin therapy.

    04:59 So instead of taking over the counter aspirin when you're a breastfeeding mom, one, we don't know the risk of Reye's sydrome, second, it's just better to use something like acetaminophen or ibuprofen.

    05:11 So avoid aspirin in most cases.

    05:15 If you're gonna take it, you really need to be pretty involved in open conversation with your health care provider to look at the benefits and the risks.

    05:24 See, as far as to say it's better to avoid aspirin during breastfeeding, however, some opinions says that a daily low dose of aspirin like the 75 to 325 may be considered a blood-thinning agent for use in breastfeeding women if they require it.

    05:41 That's the exception. So normally we would avoid aspirin but if we need some type of blood-thinning agent for the mom, maybe she developed DVT, et cetera, then the conversation needs to be held should this patient be on low dose aspirin or not.

    05:56 Now, after daily dose, low dose aspirin, no aspirin is excreted into the breast milk and salicylate levels are low.

    06:04 So aspirin use in breastfeeding should be directed by your physician only but we're thinking if you're on the low dose, you should be okay.

    06:14 You may be surprised even now that we're talking about illegal drugs but we need moms to understand without judgement that you're going to expose your baby to illegal drugs.

    06:26 If the mom is still using illegal drugs, we do wanna have open conversation with them but the breast milk is gonna need to be expressed and discarded for the next 24 hours.

    06:38 So you're gonna educate your patients even if you're extremely uncomfortable with this topic which most of us would be but it is what it is.

    06:46 We provide care to all patients without judgement, helping them to keep themselves as safe as possible, and their vulnerable populations and their babies as safe as possible.

    06:57 Now, LacMed database is a great option for you.

    07:01 This is a free and searchable database.

    07:03 It has drugs and other chemicals which nursing mothers may be exposed that's why it's called LacMed at NIH.

    07:10 It has both over the counter and prescription drugs so it would be a great idea for you to bookmark the site, keep it available to you because it'll also suggest therapeutic alternatives to these drugs, they give you one that's appropriate, it's just all kinds of great information.

    07:25 So whether you're lactating and knowing which drugs are safe or whether you're gonna be working with patients who are lactating, this is an excellent and reliable resource for you.

    About the Lecture

    The lecture Specific Drugs and Their Effect on Breast Milk (Nursing) by Rhonda Lawes is from the course Medication Safety (Nursing).

    Included Quiz Questions

    1. Take at nighttime immediately after a feeding
    2. Take in the morning immediately after a feeding
    3. Take in the evening right before a feeding
    4. Take at midday right before the baby's 1-hour nap
    1. Acetaminophen is the safest option because it is usually given to infants to treat pain and fever
    2. Avoid naproxen because of its long half-life and adverse effects
    3. Consult with a health care provider before taking aspirin
    4. Do not take ibuprofen while breastfeeding due to the high amounts of it in breast milk
    5. Acetaminophen can cause Reye syndrome in the baby or child
    1. "You must not breastfeed for 24 hours after using heroin. Otherwise, the heroin will cross over to the baby."
    2. "You must not breastfeed 12 hours after using heroin. Otherwise, the heroin will cross over to the baby."
    3. "I do not think you're capable of being a mom if you're doing drugs."
    4. "I am going to have to report your drug activity to the authorities."
    1. Antibiotic medications
    2. Opioid medications
    3. Antihypertensive medications
    4. Antianxiety medications

    Author of lecture Specific Drugs and Their Effect on Breast Milk (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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