Advising on medicines regimens during breastfeeding

Vanessa Chapman, Director, Trent Medicines Information Service & UK Drugs in Lactation Advisory ServicePublished

In many instances, medicines can be continued as normal throughout breastfeeding; we suggest you refer first to our Medicines specific advice during breastfeeding.

This page advises on strategies for the the safe use of medicines in breastfeeding mothers in instances where the medicine cannot be continued as normal whilst breastfeeding.  It also includes information on monitoring the infant.

You may also be interested in our other pages in this area: Why breastfeeding is important and how pharmacy can helpQuestions to ask when giving advice on medicines and breastfeeding and Information products that give advice on medicines and breastfeeding

Reducing the risk of side-effects to the infant whilst protecting the breastfeeding relationship

Where medicines cannot be continued as normal whilst breastfeeding, the following can be considered to reduce the risk of side-effects to the infant whilst protecting the breastfeeding relationship:

Simplify the maternal therapy regimen

It is always best to avoid unnecessary medicine use, including self-medication. If a mother is taking medicines during pregnancy, review these before delivery to help reduce risks to the infant. Consider whether the medicine could be stopped, or a non-drug option chosen instead.

Offer alternatives

Sometimes it may be better to offer an alternative that may be safer or have more evidence for its use. This could include changes to the route of administration.

A good example of this would be for the treatment of hayfever where nasal or ocular preparations may be an option over oral antihistamines.

Remember – when considering alternatives to recommend, it is just as important to ensure they are suitable for the mother’s clinical condition in addition to their suitability in breastfeeding.

Re-time feeds or withhold breastfeeding temporarily (but seek specialist advice first)

On occasions it may be possible to reduce infant exposure by either:

  • giving the maternal dose immediately after the infant has been fed with the aim of avoiding feeding at peak milk concentrations; or
  • withholding breastfeeding until after a suitable washout period of the medicine (this technique is most appropriate for short courses of a drug known to be hazardous)

Both techniques rely on knowledge of pharmacokinetic data, which may be unreliable or not readily available. In addition they are often impractical for the mother, especially where young infants are feeding frequently up to 2 hourly.

We suggest you seek further advice from your regional MI centre or UKDILAS before implementing either approach.

Monitoring the infant

Whatever strategy is used, it’s always important to give advice on what to look out for in the infant to indicate if they’re experiencing an effect from the medicine through breastmilk: for example, if the infant is more sleepy than usual and not waking up to feed regularly.  You can find information on this in our Medicines specific advice during breastfeeding.

If the infant needs monitoring, you may wish to involve all those involved with caring for the infant, for example the father or other members of the family. It is also important to let the mother know that you may need to liaise with the health visitor, midwife GP or others involved in their care.