Reference Materials
for Lactation Consultants

If you don’t find your question answered below, please feel free to reach out directly to Dr. Frank J. Nice at  drnice@drniceproducts.com.


DISCLAIMER

The information contained in this website is advisory only and is not intended to replace sound clinical judgement or individualized patient care. Dr. Nice’s Natural Products LLC disclaims all warranties, whether expressed or implied, including any warranty as the quality, accuracy, safety, or suitability of this information for any particular purpose.


Published Papers and Handouts

Medications & Breastfeeding

Recreational Drugs & Effects on Breastfeeding

Oxytocin Nasal Spray

Common Herbs & Foods Used as Galactogogues

Selection & Use of Galactogogues

Mastitis Antibiotic Algorithm

1.
Penicillinase-ResistantPenicillins

First Choice: Dicloxacillin. Cloxacillin, Methicillin, Nafcillin

2.
Macrolides (Penicillin Allergies)

First Choice: Azithromycin. Clarithromycin

3.
Aminoglycosides

Clindamycin, Vancomycin (IV) if incision and drainage are necessary

4.
Sulfamethoxazole/Trimethoprim Oral

Use if incision and drainage are necessary

5.
Cephalosporins
6.
Linezolid

 High rate of thromboplastinemia

7.
Kanamycin
8.
Chloramphenicol

DO NOT breastfeed if this drug is necessary

Recommendations for Safe and Effective Use of Medications While Breastfeeding

When counseling breastfeeding mothers who intend to take or are taking medications (prescription, over-the-counter, herbal, complementary), the following questions should be considered and asked. The provided answers are necessary to properly counsel mothers on the safe and effective use of medications while breastfeeding.

A stepwise approach based upon these answers can then be used to minimize infant drug exposure while breastfeeding. The steps evolve from not taking a medication to discontinuing breastfeeding. Steps can be skipped or combined as appropriate.

Following this approach, as outlined below, almost always allows the nursing infant to continue to breastfeed safely.

If what I’ve outlined doesn’t answer your questions, please feel free to reach out via email:  drnice@drniceproducts.com.

Frank J. Nice, RPh, DPA, CPHP


Stepwise Approach to Minimizing Infant Drug Exposure

Withhold the Drug: Avoid use of non-essential medications by enlisting the mother’s cooperation.

Try Non-Drug Therapies: Suggested therapies include: Analgesics: relaxation techniques, massage, warm baths. Cough, cold, allergy products: saline nose drops, cool mist, steam. Anti-asthmatics: avoid known allergens, particularly animals. Antacids: eat small meals, sleep with head propped, avoid head-bending activities, avoid gas-forming foods. Laxatives: eat high fiber cereal, prunes, or hot liquids with breakfast. Anti-diarrheals: discontinue solids 12-24 hours, increase fluids, eat toast / saltine crackers.

Delay Therapy: Mothers who are ready to wean the infant might be able to delay elective drug therapy or elective surgery.

Choose Drugs That Pass Poorly Into Milk: Within some drug classes there are large differences among class members in drug distribution into milk.

Choose More Breastfeeding Compatible Dosage Forms: Take lowest recommended dose, avoid extra-strength and long acting preparations, avoid combination ingredient products.

Choose an Alternative Route of Administration: Local application of drugs to the affected maternal site may minimize drug concentrations in milk and subsequently the infant’s dose.

Avoid Nursing at Times of Peak Drug Concentrations in Milk: Nursing before a dose is given may avoid the peak drug concentrations in milk that occur about 1-3 hours after an oral dose. This works best for drugs with short half-lives.

Administer the Drug Before the Infant’s Longest Sleep Period: This will minimize the infant’s dose and is useful for long-acting drugs that can be given once daily.

Temporarily Withhold Breastfeeding: Depending on the estimated length of drug therapy, nursing can be temporarily withheld. Mothers may be able to pump a sufficient quantity of milk beforehand for use during therapy. The pharmacokinetics of the drug must be examined to determine when the resumption of breastfeeding is advisable or when milk pumped while taking the drug (including some radioactive drugs) can be used safely later.

Discontinue Nursing: A few drugs are too toxic to allow nursing and may be necessary for the mother’s health.

Stepwise Approach to Minimizing Infant Drug Exposure, Nice FJ, Luo AC: Medications and Breastfeeding: Current Concepts. Journal of the American Pharmacists Association, 52: 86-94 (January/February) 2012

Questions to Ask

I. Medication Usage: Questions for Mom

How old is the baby?

This is the basic information needed to evaluate any situation involving drug use.

Was your baby full-term or premature?

The mother may be seeking information on whether to continue breastfeeding, if and when she takes the drug. She may be questioning whether she is acting ‘correctly’ by taking the drug and continuing to nurse her baby. Also, she may have concerns about possible adverse effects to her infant.

What is your baby’s weight?

Knowing the answer to this question can help the mother determine the ability of the baby’s body to manage the amount of medication he or she could receive via breastmilk. The more the baby weighs, the more drug a breastfeeding baby can safely handle.

Is your baby currently receiving any medication?

The drug prescribed for the mother may interact with any medication the baby is taking. This is important information for the lactation consultant, pharmacist, and provider to determine the best recommendation for the situation.

What does the healthcare provider say about continued breastfeeding and taking the drug?

A provider’s philosophy and education about breastfeeding as well as knowledge of drug effects on breastfeeding, can play a large role in the provider’s opinion as to whether the mother should continue to breastfeed. The mother should have a discussion with the provider about recommendations. If the recommendations do not feel right with the parents, they could seek a second opinion.

What is the drug’s dosage schedule and how often does the baby nurse?

If a drug must be taken and breastfeeding continued, it may be possible to schedule the doses so that the peak plasma and milk levels of the drug do not coincide with breastfeeding or milk expression sessions. In most cases, it is best for the mother to breastfeed or pump just before taking a dose of a drug and/or at least two hours after taking a dose. Short-acting drugs taken on an every three to six hour schedule usually reach peak plasma and milk levels in approximately one hour.

Do you know how to hand-express milk or do you have access to a breast pump?

In some cases, breastfeeding can be stopped temporarily while a drug is administered. In these situations, milk expression must continue to prevent engorgement and to maintain the milk supply. Lactation Consultants or volunteer  La Leche League Leaders can provide you with more information.

Is this the first breastfed baby for this family?

Experienced breastfeeding mothers may be more knowledgable and determined to continue when informed they need to combine a drug with breastfeeding. If this is your first baby, find a supportive pharmacist or lactation consultant to review your options.

II. Medication Usage: Questions About Baby

How old is the baby?

Knowing this gives an indication of the infant’s ability to handle a particular drug. Also, it aids determining the infant’s feeding schedule which may influence dosage scheduling.

Was your baby full-term or premature?

The answer to this question supplies added information that helps determine the infant’s ability to detoxify drugs.

What is your baby’s weight?

This fact may be relevant to the quantity of the drug the baby may be able to tolerate without any adverse effects.

Is your baby currently receiving any medication?

Any medication that the infant is receiving can interact with medication the infant receives through breastmilk.

If the baby is receiving formula, how much does the baby receive per day?

If the baby is receiving any formula, it lessens the amount of breastmilk the baby receives. Therefore, the impact of a medication in breastmilk will be different.

Nice News for Nursing Moms

Dr. Frank J. Nice blogs about topics related to breastfeeding and lactation pharmacology, answers questions and offers trusted advice to both Lactation Consultants & Nursing Moms.

Questions? We’d love to hear from you.

If you have breastfeeding or lactation questions for Dr. Nice or you’re interested in scheduling a consultation or lecture, please reach out via email. 

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