What medications should be avoided while breastfeeding?

From the Guidelines

Breastfeeding mothers should avoid certain medications, including high-dose aspirin, certain chemotherapy drugs, ergotamine, lithium, and drugs of abuse, as they can pose potential risks to the infant. According to the guideline on anaesthesia and sedation in breastfeeding women 2020: guideline from the association of anaesthetists 1, medications such as tramadol and oxycodone should be used with caution, as they can cause respiratory depression and sedation in infants.

• Specific medications to avoid or use with caution while breastfeeding include:
  • Tramadol: observe child for unusual drowsiness 1
  • Oxycodone: greater risk of drowsiness in doses > 40 mg/day 1
  • Codeine: should not be used by breastfeeding women due to concerns of excessive sedation in some infants 1
  • High-dose aspirin: should not be used in analgesic doses, but low-dose aspirin for anti-platelet action can be used in breastfeeding women if strongly indicated 1
• On the other hand, some medications are considered safe for use during breastfeeding, including:
  • Ibuprofen: has been used extensively for postpartum pain and during lactation, and is considered safe to use during breastfeeding 1
  • Diclofenac: small amounts are detected in breast milk, but it is considered safe to use during breastfeeding 1
  • Naproxen: although it has a longer half-life than diclofenac, naproxen is widely used after caesarean section, and breastfeeding may continue as normal 1
  • Celecoxib: the relative dose that infants are exposed to via milk is very low, and breastfeeding may continue 1
  • Ketorolac and parecoxib: low levels are detected in breast milk without demonstrable adverse effects in the neonate, and are compatible with breastfeeding 1 It is essential to consult with a healthcare provider before taking any medication while breastfeeding, as they can recommend safer alternatives or appropriate timing strategies to minimize infant exposure 1. Many medications are actually compatible with breastfeeding, and unnecessarily stopping breastfeeding due to medication concerns can deprive the infant of important nutritional and immunological benefits.

From the FDA Drug Label

Oxycodone is present in breast milk. Published lactation studies report variable concentrations of oxycodone in breast milk with administration of immediate-release oxycodone to nursing mothers in the early postpartum period. Infants exposed to oxycodone hydrochloride tablets through breast milk should be monitored for excess sedation and respiratory depression. Carbamazepine and its epoxide metabolite are transferred to breast milk. The ratio of the concentration in breast milk to that in maternal plasma is about 0.4 for carbamazepine and about 0.

Medications to Worry About While Breastfeeding:

• Oxycodone: due to the risk of excess sedation and respiratory depression in infants
• Carbamazepine: as it is transferred to breast milk and may affect the infant

These medications should be used with caution and under medical supervision while breastfeeding. Monitoring of the infant for potential adverse effects is recommended. 2 3

From the Research

Medications to Avoid While Breastfeeding

There are several medications that should be avoided or used with caution while breastfeeding, including:

• Lithium, as it can be excreted in high amounts in breast milk and may pose a risk to the infant 4, 5, 6
• Certain anticonvulsants, such as ethosuximide, phenobarbital, primidone, lamotrigine, and topiramate, which may result in higher exposure levels to the breastfed infant 4
• Some antidepressants, such as doxepin, and certain selective serotonin reuptake inhibitors (SSRIs), which may require careful consideration and monitoring 5, 6
• Antipsychotic medications, which may pose a risk of toxicity and abnormal neurological development in the infant 5
• Stimulant medications, which may decrease milk supply 7
• Opioids, which can cause infant sedation 7
• Herbal supplements, which may pose a risk of impurities and lack of study of effects on breastfed infants 7
• Radiopharmaceuticals, such as iodine 131, which can accumulate in the lactating breast and increase risk to the infant 7

Medications That Are Generally Considered Safe

Some medications that are generally considered safe to use while breastfeeding include:

• Most tricyclic antidepressants 5
• Certain SSRIs, such as fluoxetine and citalopram, although they may not be the first choice for treatment 6
• Insulin, metformin, and second-generation sulfonylureas for treating diabetes mellitus 7
• Inhaled and nasal treatments for asthma and allergic rhinitis 7
• Acetaminophen and ibuprofen as analgesics 7
• Nonhormonal and progestin-only contraceptives 7