From the Guidelines
Proton pump inhibitors (PPIs) can be taken while breastfeeding, as they are considered safe and transfer into breast milk in very small amounts that are unlikely to cause harm to a nursing infant. According to the American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1, many medications can be safely used during lactation. Although PPIs are not explicitly mentioned in the guideline, their safety profile during breastfeeding is well-established in other sources. The American Academy of Pediatrics considers PPIs compatible with breastfeeding.
Key Points to Consider
- PPIs, such as omeprazole, esomeprazole, pantoprazole, lansoprazole, and rabeprazole, are used to treat conditions like gastroesophageal reflux disease (GERD), ulcers, and heartburn.
- To minimize the amount of PPI in breast milk during the next feeding, it's best to take the medication immediately after breastfeeding.
- Standard adult dosing can be followed as prescribed for the specific condition, but it's recommended to use the lowest effective dose for the shortest duration necessary.
- If concerns arise about taking PPIs while breastfeeding, discussing them with a healthcare provider can help weigh the benefits of treating the condition against any potential risks.
Medication Safety During Breastfeeding
- The guideline provides a list of medications that are considered safe or conditionally safe during breastfeeding, including HCQ, infliximab, etanercept, adalimumab, golimumab, certolizumab, rituximab, NSAIDs, sulfasalazine, colchicine, AZA, cyclosporine, tacrolimus, anakinra, belimumab, abatacept, tocilizumab, secukinumab, and ustekinumab 1.
- However, some medications, such as CYC, leflunomide, MMF, and thalidomide, are strongly recommended against during breastfeeding, while MTX is conditionally recommended against due to potential accumulation in neonatal tissues 1.
From the Research
Proton Pump Inhibitors and Breastfeeding
- There are no direct studies provided that assess the safety of taking proton pump inhibitors (PPIs) while breastfeeding.
- However, studies have investigated the use of PPIs during pregnancy, which may provide some insight into their potential effects on lactation and infant health 2, 3.
- A study published in 2010 found that exposure to PPIs during the first trimester of pregnancy was not associated with a significantly increased risk of major birth defects 2.
- Another study published in 2012 found that intrauterine exposure to PPIs was not associated with an increased risk of congenital malformations, perinatal mortality, or morbidity 3.
- While these studies do not directly address the safety of PPIs during breastfeeding, they suggest that PPIs may not pose a significant risk to the fetus during pregnancy.
- It is essential to consult with a healthcare provider to determine the safety of taking PPIs while breastfeeding, as they can provide personalized guidance and recommendations based on individual circumstances.
Available Information on PPIs
- PPIs are widely used to treat acid-related diseases, and their effectiveness and safety have been extensively studied 4, 5.
- A study published in 2018 found that PPIs can be used interchangeably based on potency, and that twice-daily PPIs are more effective in increasing efficacy than once-daily PPIs 4.
- Another study published in 2014 investigated PPI prescribing patterns in newborns and infants, but did not address the use of PPIs during breastfeeding 6.
- A review article published in 2020 discussed the appropriate clinical indications for PPIs, their associated adverse events, and the importance of balancing benefits and risks 5.