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Using gastrointestinal antispasmodics during breastfeeding

Published
Topics: AlverineDicycloverineGastrointestinal disorders · Hyoscine butylbromideMebeverinePeppermint oilPropanthelineSafety in Breastfeeding ·

Hyoscine butylbromide, propantheline or peppermint oil are preferred choices during breastfeeding. Recommendations apply to full term and healthy infants.

Contents

  1. General considerations
  2. Recommendations
  3. Breast milk supply
  4. Specific recommendations
    1. Alverine
    2. Dicycloverine
    3. Hyoscine butylbromide
    4. Mebeverine
    5. Peppermint oil
    6. Propantheline
  6. Patient Information
  7. Contact us
  8. About our recommendations
  9. Bibliography

General considerations

It is important to complete an individual risk assessment (SPS page) for your patient and to apply the principles of prescribing in breastfeeding (SPS page) when looking at the available information and making treatment decisions.

Recommendations

Hyoscine butylbromide, propantheline or peppermint oil are considered preferred choices in breastfeeding.

Mebeverine and alverine can also be used.

There is limited evidence for the use of antispasmodics during breastfeeding and therefore recommendations are generally made on the properties of the medicine. The choice of medicine will depend on symptoms.

Breast milk supply

There is a theoretical risk that suppression of breast milk production could occur with antimuscarinic drugs (atropine, hyoscine butylbromide, propantheline). There have also been conflicting reports that peppermint may increase or decrease breast milk production. There is no published evidence to support this.

Once breastfeeding is established, any effect on breast milk production becomes less significant.

It is therefore advisable to monitor breastfed infants for adequate feeding and poor weight gain, especially if used long-term.

Specific recommendations

Use with caution

Alverine can be used with caution during breastfeeding, but other options are preferred.

Monitoring

As a precaution, monitor for irritability, difficult or laboured breathing, yellowing of skin or whites of the eyes (signs of jaundice), vomiting, rash.

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breastfeeding.

Not recommended

Dicycloverine (dicyclomine) is not recommended for use during breastfeeding.

Further information

Small amounts pass into breast milk. However, a possible case of apnoea was reported in a breastfed infant exposed to dicycloverine, so use during breastfeeding is not recommended.

Preferred choice

Hyoscine butylbromide can be used during breastfeeding.

Monitoring

As a precaution, monitor infants for drowsiness, not waking to feed or poor feeding, adequate weight gain, irritability, constipation and urinary retention (decrease in wet nappies).

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breastfeeding. However, low levels are anticipated in breast milk due to the medicine’s properties.

Use with caution

Mebeverine can be used during breastfeeding, but infant monitoring is required.

Monitoring

As a precaution, monitor infants for allergic reactions or any other signs of unusual behaviour.

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breastfeeding. Low levels are anticipated in breast milk due to the medicine’s properties. However, the medicine’s properties are not as favourable as some of the others.

Preferred choice

Peppermint oil can be used during breastfeeding.

Monitoring

As a precaution, monitor breastfed infants for poor feeding and adequate weight gain, gastro-intestinal disturbances, irritability, and rash.

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

The main component of peppermint oil is menthol which passes into breast milk in negligible amounts so is not considered to pose a risk to breastfed infants.

Preferred choice

Propantheline can be used during breastfeeding.

Monitoring

As a precaution, monitor infants for drowsiness, not waking to feed or poor feeding, adequate weight gain, irritability, constipation and urinary retention (decrease in wet nappies).

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breastfeeding. However, low levels are anticipated in breast milk due to the medicine’s properties.

Propantheline is used in infants from 1 month of age. These doses will be far higher than the amounts expected in breast milk.

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS) (SPS page), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.