What medications are safe to take while breastfeeding?

Medications Safe During Breastfeeding

Most medications are compatible with breastfeeding, and only a very limited number are contraindicated—you should consult LactMed (the NIH Drugs and Lactation Database) for specific medication safety information rather than unnecessarily advising mothers to stop breastfeeding. 1

General Principles for Medication Safety

The vast majority of maternal medications are safe during breastfeeding and do not require cessation of nursing. 1, 2 The key is selecting medications with favorable pharmacokinetic properties and using reliable resources to verify safety rather than defaulting to stopping breastfeeding out of excessive caution. 2, 3

Primary Resource for Medication Safety

• LactMed (Drugs and Lactation Database) published by the National Library of Medicine is the most comprehensive and authoritative source for medication safety during breastfeeding 1
• This free online database should be your first-line reference for any medication question 1

Specific Medication Categories

Pain Management (Safest Options)

• Acetaminophen (paracetamol) and ibuprofen are the preferred analgesics during breastfeeding 4, 2
• Both can be used immediately without interrupting nursing or expressing/discarding milk 4
• The American Academy of Pediatrics explicitly recommends these non-opioid drugs as compatible with breastfeeding 4
• Use the lowest effective dose for the shortest duration 4
• Other safe NSAIDs include diclofenac, naproxen, and ketorolac 5, 4
• Ketorolac (IV Toradol) is safe during breastfeeding due to minimal transfer into breast milk, making it preferable to opioids 5
• Breastfeeding can continue immediately after ketorolac administration without any waiting period 5

Important caveat: For infants less than 6 weeks of age (corrected for gestation), exercise extra caution with any medication due to immature hepatic and renal function, though NSAIDs remain safer than opioids 5, 4

Opioid Analgesics (Use With Caution)

• Maternal opioid use can cause infant sedation and respiratory depression 5, 2
• Opioids should be avoided when safer alternatives like NSAIDs are available 5, 4

Mental Health Medications

• Most antidepressants are compatible with breastfeeding 2
• Priority should be given to effectively treating the mother, often continuing medications that were effective during pregnancy 2
• Stimulant medications may decrease milk supply and require monitoring 2

Diabetes Management

• Insulin, metformin, and second-generation sulfonylureas are generally preferred for treating diabetes during breastfeeding 2
• Newer diabetic agents require caution due to lack of lactation studies 2

Asthma and Allergy Medications

• Inhaled and nasal treatments for asthma and allergic rhinitis are unlikely to affect breastfed infants 2

Contraceptives

• Nonhormonal and progestin-only contraceptives are preferred over combination oral contraceptives during breastfeeding 2
• Combination oral contraceptives may reduce milk supply 2

Galactagogues (Milk Supply Enhancement)

• Metoclopramide is FDA-approved and compatible with breastfeeding for increasing milk supply 6
• The American College of Obstetricians and Gynecologists recommends optimizing non-pharmacologic interventions first (frequent feeding/pumping, proper latch, adequate hydration) before considering metoclopramide 6
• Exclude medical causes of low supply (retained placental fragments, thyroid dysfunction, insufficient glandular tissue) before prescribing 6
• Domperidone is also used but is not FDA-approved in the United States 6

Absolutely Contraindicated Medications

Very few drugs are absolutely contraindicated during breastfeeding: 2, 7

• Antineoplastic (chemotherapy) drugs 7
• Radiopharmaceuticals, particularly iodine-131 (accumulates in lactating breast tissue) 2
• Drugs of abuse 7

Important note: Contrast agents for CT or MRI are NOT concerning during lactation and do not require interruption of breastfeeding 2

Practical Prescribing Algorithm

When prescribing for a breastfeeding mother, follow this sequence: 2, 3

1. Determine if medication is truly necessary 3
2. Select the safest drug available with these properties: 3
   • Safe when administered directly to infants
   • Low milk:plasma ratio
   • Short half-life
   • High molecular weight
   • High protein binding in maternal serum
   • Ionized in maternal plasma
   • Less lipophilic
3. Consult LactMed database for specific safety information 1
4. Advise timing: Take medication just after breastfeeding or before the infant's longest sleep period 3
5. Consult with the infant's pediatrician when appropriate 3

Common Pitfalls to Avoid

• Never advise stopping breastfeeding without consulting reliable resources first 3, 8
• Lack of information or misinformation often leads to unnecessary cessation of breastfeeding 3, 8
• Fear of litigation should not drive decisions to stop breastfeeding when medications are safe 3
• Herbal supplements are concerning due to risk of impurities and lack of studies on effects in breastfed infants 2

Substance Use Considerations

Alcohol

• Moderate alcohol consumption (up to 1 standard drink per day) is not known to be harmful to the infant if the mother waits at least 2 hours after drinking before nursing 1
• Breast milk alcohol concentrations peak 30-60 minutes after consumption 1

Tobacco/Nicotine

• Breastfeeding mothers should be strongly encouraged to stop smoking 1
• If unable to quit, minimize smoking and never smoke while breastfeeding or inside the home/car 1
• Nicotine cessation products may be used while breastfeeding 1
• Preferably smoke/vape immediately after breastfeeding to minimize transmission to infant 1