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Effects of medications and other substances on milk content[edit]

Almost all medicines pass into breastmilk in small amounts by a concentration gradient.[1] Some have no effect on the baby and can be used while breastfeeding, while other medications may be harmful to the infant.[2] [3] Women with hypothyroidism may be unable to produce milk.[4][5] Alcohol use during pregnancy carries a significant risk of serious birth defects, but consuming alcohol after the birth of the infant is considered safe.[6]

Pesticides and other toxic substances bioaccumulate; i.e., creatures higher up the food chain will store more of them in their body fat. This is an issue in particular for the Inuit, whose traditional diet is predominantly meat. Studies are looking at the effects of polychlorinated biphenyls and persistent organic pollutants in the body; the breast milk of Inuit mothers is extraordinarily high in toxic compounds.[7]

Effects of medications and other substances on milk content[edit][edit]

Almost all medicines pass into breastmilk in small amounts by a concentration gradient.[8] The amount of drug bound by maternal plasma proteins, the size of the drug molecule, the pH of the drug, and if the drug is lipid soluble or not all determine whether the medication will pass into breastmilk.[9] Medications that are non-protein bound, low in molecular weight, or highly lipid-soluble are more likely to enter the breast milk in larger quantities.[10] Some have no effect on the baby and can be used while breastfeeding,[65] while other medications may be harmful to the infant.[10]

Some generally safe medications that the mother can use while breastfeeding include:

Examples of Safe Medications for Breastfeeding Mothers
Condition Medication Side Effects/Notes
Allergic Rhinitis Beclomethasone (Beconase)
Pseudoephedrine (Sudafed) May cause decreased milk production
Diphenhydramine (Benadryl) May cause tiredness or irritability in infants[10]
Anesthetics
Anesthetics (local) Lidocaine, Bupivacaine[11]
Anesthetics (systemic), muscle relaxants Propofol, Rocuronium, Thiopental, Succinylcholine
Antibiotics Penicillins, Cephalosporins, Aminoglycosides. Macrolides May cause diarrhea and thrush in the infant[11]
Asthma Fluticasone (Flovent)[10]
Prednisone (Deltasone)[10]
Cardiovascular Beta Blockers Different beta blockers vary widely in the amount excreted into breast milk. For example, Atenolol, Nadalol, and Sotalol are excreted in higher amounts and may lead to low blood pressure or low heart rate in the infant. [10]
Diabetes Insulin
Glyburide (Micronase), Glipizide (Glucotrol)
Depression Sertraline (Zoloft)[10]
Paroxetine (Paxil)
Pain Ibuprofen (Motrin)
Morphine, codeine, hydrocodone[10]
Acetaminophen(Tylenol)

On the other hand, there are medications that may be toxic to the baby while breastfeeding, and thus should not be used in breast-feeding mothers, such as:

Examples of Medications To Avoid in Breastfeeding Mothers[10][9]
Medication Side Effects/Notes
Amiodarone Long half-life, may affect thyroid of infant
Anticancer drugs Causes bone marrow suppression
Bromocriptine (Parlodel)
Cyclosporine (Sandimmune) Possible immune suppression[12]
Lithium Need close therapeutic monitoring
Methotrexate (Rheumatrex) Possible immune suppression[12]

**SHOULD I PUT "A MORE EXTENSIVE LIST CAN BE FOUND AT ______"** https://reader.elsevier.com/reader/sd/pii/S0733862703000373?token=ABB8A8E0CA177D0D9A2B93D7583365CEA31B84691A2ACA7516F06C68AAF3938357C30A0E85782EC3A92E288E16AD323B

Furthermore, drugs of abuse, such as cocaine, amphetamines, heroin, and marijuana cause adverse effects on the infant during breastfeeding. Adverse effects include seizures, tremors, restlessness, and diarrhea.[12]

To reduce infant exposure to medications used by the mother, use topical therapy or avoid taking the medication during breastfeeding times when possible.[1]


There are some medications that will decrease the amount of breast milk produced…..

Alternatively, there are some medications that may stimulate the production of breast milk. These medications may be beneficial in cases where women with hypothyroidism may be unable to produce milk.[66][67] A Cochrane review looked at the drug domperidone (10 mg three times per day) with results showing significant increase in volume of milk produced over a period of one to two weeks.[13] Another review stated low evidence that use of Domperidone and Metoclopramide to enhance milk supply works. Instead, non-pharmacological approaches such as support and more frequent breastfeeding may be more efficacious.[9] --> MAYBE ADD THIS TO THE PRODUCTION SECTION


Finally, there are other substances besides medications that may appear in breast milk. Alcohol use during pregnancy carries a significant risk of serious birth defects, but consuming alcohol after the birth of the infant is considered safe.[68]

High caffeine intake by breastfeeding mothers may cause their infants to have trouble sleeping or irritability. [9]

A meta-analysis has shown that breastfeeding mothers who smoke expose their infants to nicotine, which may cause respiratory illnesses, including otitis media in the nursing infant.[12]

Pesticides and other toxic substances bioaccumulate; i.e., creatures higher up the food chain will store more of them in their body fat. This is an issue in particular for the Inuit, whose traditional diet is predominantly meat. Studies are looking at the effects of polychlorinated biphenyls and persistent organic pollutants in the body; the breast milk of Inuit mothers is extraordinarily high in toxic compounds.[69]

The CDC has provided some resources for breastfeeding mothers to reference for safe medication use, including LactMed, Mother to Baby, and The InfantRisk Center.[14] **LOOK AT THESE WEBSITES TO SEE IF I CAN ADD MORE TO MY CHARTS**

References[edit]

  1. ^ Atkinson, H. C.; Begg, E. J.; Darlow, B. A. (1988-04-01). "Drugs in Human Milk". Clinical Pharmacokinetics. 14 (4): 217–240. doi:10.2165/00003088-198814040-00003. ISSN 1179-1926.
  2. ^ "Breastfeeding" (PDF). Office on Women’s Health, U.S. Department of Health and Human Services. 2014. Retrieved 20 July 2017.Public Domain This article incorporates text from this source, which is in the public domain.
  3. ^ Barnhart, Donna; Iii, Luis S. Gonzalez; Spencer, Jeanne P. (2001-07-01). "Medications in the Breast-Feeding Mother". American Family Physician. 64 (1): 119. ISSN 0002-838X.
  4. ^ "Tyroid disease in Women". Office on Women’s Health, U.S. Department of Health and Human Services. 1 February 2017. Retrieved 20 July 2017.Public Domain This article incorporates text from this source, which is in the public domain.
  5. ^ "Postpartum Thyroiditis" (PDF). American Thyroid Association. 2014. Retrieved 20 July 2017.
  6. ^ "Guidelines for the identification and management of substance use and substance use disorders in pregnancy" (PDF). World Health Organization. 2014. Retrieved 11 August 2017.
  7. ^ Silent Snow: The Slow Poisoning of the Arctic by Marla Cone, Grove Press.
  8. ^ Atkinson, H.C.; Begg, E.J.; Darlow, B.A. (1988-4). "Drugs in Human Milk: Clinical Pharmacokinetic Considerations". Clinical Pharmacokinetics. 14 (4): 217–240. doi:10.2165/00003088-198814040-00003. ISSN 0312-5963. {{cite journal}}: Check date values in: |date= (help)
  9. ^ a b c d Hotham, Neil; Hotham, Elizabeth (2015-10-01). "Drugs in breastfeeding". Australian Prescriber. 38 (5): 156–159. doi:10.18773/austprescr.2015.056. PMC 4657301. PMID 26648652.{{cite journal}}: CS1 maint: PMC format (link)
  10. ^ a b c d e f g h i Barnhart, Donna; Iii, Luis S. Gonzalez; Spencer, Jeanne P. (2001-07-01). "Medications in the Breast-Feeding Mother". American Family Physician. 64 (1): 119. ISSN 0002-838X.
  11. ^ a b Verstegen, Ruud H. J.; Ito, Shinya (2019). "Drugs in lactation: Drugs in lactation". Journal of Obstetrics and Gynaecology Research. 45 (3): 522–531. doi:10.1111/jog.13899.
  12. ^ a b c d Committee on Drugs (2001-09-01). "The Transfer of Drugs and Other Chemicals Into Human Milk". PEDIATRICS. 108 (3): 776–789. doi:10.1542/peds.108.3.776. ISSN 0031-4005.
  13. ^ Donovan, Timothy J; Buchanan, Kerry (2012-03-14). Cochrane Pregnancy and Childbirth Group (ed.). "Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005544.pub2.
  14. ^ CDC (2018-01-24). "Prescription Medication Use". Centers for Disease Control and Prevention. Retrieved 2019-08-02.
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