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Using laxatives during breastfeeding

Published Last updated See all updates
Topics: BisacodylDocusateGastrointestinal disorders · GlycerolIspaghula huskLactuloseMacrogol 3350PrucaloprideSafety in BreastfeedingSennaSodium citrateSodium picosulfate ·

Any laxative can be used during breastfeeding although prucalopride should be used with caution. Recommendations apply to full term and healthy infants.

Contents

  1. General considerations
  2. Recommendations
  3. Clinical considerations
  4. Specific recommendations
  5. Bulk-forming laxatives
    1. Ispaghula husk
  7. Osmotic laxatives
    1. Lactulose
    2. Macrogol 3350
    3. Sodium citrate enema
  9. Stimulant laxatives
    1. Bisacodyl
    2. Docusate
    3. Glycerol suppositories
    4. Senna
    5. Sodium picosulfate
  11. Selective serotonin 5HT4-receptor agonists
    1. Prucalopride
  13. Patient Information
  14. Contact us
  15. About our recommendations
  16. Bibliography
  17. Update history

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

Any laxative can be used during breastfeeding as most are either not absorbed or minimally absorbed from the gastrointestinal tract leading to low or negligible levels in breast milk.

Prucalopride can be used with caution whilst breastfeeding as it is excreted into breast milk in small levels.  Other laxatives are preferable but, given its place in therapy, may already have been tried.

Lifestyle interventions such as increased dietary fibre and exercise should always be tried first. Maintaining fluid intake will also help with milk supply. If a laxative is needed, always use the lowest dose for the shortest time possible.

Clinical considerations

There are three main types of laxatives—bulk-forming, osmotic or stimulant. In addition, prucalopride is a selective serotonin 5HT4-receptor agonist which is used for chronic constipation where other laxatives have failed.

Treatment choice should be primarily based on clinical indications, with suitability in breastfeeding as a secondary consideration.

In some cases, constipation may be a sign of dehydration.  Drinking fluids is important to maintain sufficient breast milk supply in addition to helping relieve constipation.

Specific recommendations

The following specific laxative recommendations have been grouped by mechanism of action.

Bulk-forming laxatives

Preferred choice

Ispaghula husk can be used during breastfeeding.

Infant monitoring

No specific infant monitoring is usually required.

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

Although there is no evidence for use in breastfeeding, ispaghula husk is not absorbed by the body and will not appear in breast milk. Infant side effects are therefore not expected.

Ispaghula husk can be used in infants over 1 month old.  Doses used will be much higher than the amounts the infant may be exposed to via breast milk.

Osmotic laxatives

Preferred choice

Lactulose can be used during breastfeeding.

Infant monitoring

As a precaution monitor the infant for diarrhoea, vomiting or irritability.

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

Although there is no evidence for use in breastfeeding, its very low oral bioavailability makes passage into breast milk highly unlikely. Infant side effects are therefore not expected.

Lactulose can be used in infants over 1 month old.  Doses used will be much higher than the amounts the infant may be exposed to via breast milk.

Preferred choice

Macrogol 3350 can be used during breastfeeding.

Infant monitoring

As a precaution monitor the infant for diarrhoea, vomiting or irritability.

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

Although there is no evidence for use in breastfeeding, its negligible oral bioavailability and high molecular weight will limit passage into breast milk and absorption by the infant. Infant side effects are therefore not expected.

Preferred choice

Sodium citrate enemas can be used during breastfeeding.

Infant monitoring

No specific infant monitoring is usually required.

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

Although there is no evidence for use in breastfeeding passage into breast milk is expected to be insignificant due to minimal systemic rectal absorption. Any that is absorbed is metabolised to bicarbonate. Both sodium and bicarbonate are found naturally in breast milk. Infant side effects are therefore not expected.

Stimulant laxatives

Preferred choice

Bisacodyl can be used during breastfeeding.

Infant monitoring

As a precaution monitor the infant for diarrhoea or irritability.

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

Bisacodyl is poorly absorbed from both oral or rectal formulations and is converted to an active metabolite.

Very limited evidence suggest that the active metabolite is not detected in breast milk.  Any bisocodyl or active metabolite that could be present in breastmilk would also be poorly absorbed by the infant.  Infant side effects are therefore not expected.

Preferred choice

Docusate can be used during breastfeeding.

Infant monitoring

No specific infant monitoring is usually required.

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

Although there is no evidence for use in breastfeeding, its low oral bioavailability will limit passage into breast milk and absorption by the infant. Infant side effects are therefore not expected.

Preferred choice

Glycerol suppositories can be used during breastfeeding.

Infant monitoring

No specific infant monitoring is usually required.

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

Although there is no evidence for use in breastfeeding, its negligible rectal bioavailability will limit passage into breast milk.

Glycerol is found naturally in breast milk, and infant side effects are therefore not expected.

Glycerol suppositories can be used in infants.  Doses used will be much higher than the amounts the infant may be exposed to via breast milk.

Preferred choice

Standardised senna preparations can be used during breastfeeding.

Infant monitoring

As a precaution monitor the infant for diarrhoea or irritability.

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

Limited published evidence has shown negligible amounts in breast milk, due to its poor oral absorption and high molecular weight. No side effects have been reported in breastfed infants.

Non-standardised senna preparations are available to purchase as herbal or alternative products.  The ingredients or potency in these products may vary and patients should be advised that standardised products should be used.

Senna can be used in infants over 1 month old.  Doses used will be much higher than the amounts the infant may be exposed to via breast milk.

Preferred choice

Sodium picosulfate can be used in breastfeeding.

Infant monitoring

As a precaution monitor the infant for diarrhoea or irritability

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

Sodium picosulfate has low oral bioavailability and is converted to an active metabolite. Very limited evidence suggests that the active metabolite is not detected in breast milk. Infant side effects are therefore not expected.

Sodium picosulfate can be used in infants over 1 month old.  Doses used will be much higher than the amounts the infant may be exposed to via breast milk.

Selective serotonin 5HT4-receptor agonists

Use with caution

Prucalopride can be used in breastfeeding with caution.  Other types of laxatives are preferable but, given its place in therapy, may already have been tried.

Infant monitoring

As a precaution, monitor the infant for diarrhoea vomiting, drowsiness, irritability, poor feeding or adequate weight gain.

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

Very limited data indicate small levels in breast milk.

Although there is no published evidence of infant levels, side effects are unlikely.

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 are now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.

Update history

  1. Editorial change only.
  1. Published