What medications for gastritis are safe during lactation (breastfeeding)?

Medications for Gastritis Safe During Lactation

Several medications for gastritis are safe during breastfeeding, including antacids, sucralfate, most H2-receptor antagonists, and proton pump inhibitors. 1

Safe First-Line Options

• Antacids (calcium carbonate, aluminum hydroxide): These are minimally absorbed systemically and considered safe during breastfeeding 1
• Sucralfate: Not absorbed systemically, making it a safe option for nursing mothers 1
• H2-receptor antagonists:
  • Famotidine and nizatidine are preferred H2-blockers as they are excreted into breast milk to a lesser extent than cimetidine or ranitidine 1
  • Cimetidine is specifically listed by the American Academy of Pediatrics as compatible with breastfeeding, though it transfers into milk more than other H2-blockers 1

Proton Pump Inhibitors (PPIs)

• Most PPIs are considered compatible with breastfeeding due to:
  • Low oral bioavailability in infants 2
  • Minimal transfer into breast milk 3
  • Short half-lives that limit infant exposure 2

Anti-inflammatory Medications

• Low-dose corticosteroids (prednisone <20 mg daily) are compatible with breastfeeding 4
• For doses ≥20 mg daily, it's recommended to delay breastfeeding or discard breast milk accumulated in the 4 hours following administration 4
• NSAIDs are conditionally recommended as compatible with breastfeeding for short-term use 4
  • Ibuprofen is preferred for long-term treatment due to its short half-life and lack of active metabolites 5

Antibiotics for H. pylori-Associated Gastritis

• Amoxicillin/clavulanic acid is safe during breastfeeding based on limited human data 4
• Macrolides (clarithromycin, azithromycin):
  • Generally considered safe, but there is a very low risk of infantile hypertrophic pyloric stenosis in infants exposed during the first 13 days of breastfeeding 4, 6
• Metronidazole is deemed safe based on cohort studies showing no significant adverse effects in infants 4

Medications to Avoid or Use with Caution

• Methotrexate should be avoided during breastfeeding as it may accumulate in neonatal tissues despite minimal passage into breast milk 4
• Cyclophosphamide is strongly recommended against during breastfeeding 4

Practical Recommendations

• When prescribing medications for a breastfeeding patient with gastritis, select those with the lowest risk to the infant 2
• Time medication dosing to be taken just after breastfeeding or before the infant's longest sleep interval to minimize exposure 2, 3
• The amount of medication that enters breast milk is generally small and much less than known safe doses given directly to infants 7
• Most commonly used drugs for gastritis are relatively safe for breastfed babies 7

Monitoring

• Monitor the infant for potential side effects, particularly with medications that have limited safety data 3
• For most gastritis medications, the benefits of continuing breastfeeding outweigh the minimal risks to the infant 3, 1