OTC Medication Use in Breastfeeding

Introduction

Since medicines taken by breastfeeding mothers may pass into breast milk, this article explores the safe use of over-the-counter medications while breastfeeding

  • Medicines that passed into breast milk in small quantities rarely affects breastfed babies.



Pain

Paracetamol is considered compatible with breastfeeding when used in usual recommended doses to treat mild pain, such as headaches, toothaches, muscular pains or to reduce fever.

NSAIDs are safe to help relieve pain and inflammation, but selective NSAIDs (COX-2 inhibitors) have limited data.

  • Of the NSAIDs, ibuprofen is considered the drug of choice.
  • Naproxen should be used cautiously in breastfeeding women due to its long half-life and has been documented to cause prolonged bleeding, anaemia and thrombocytopenia in a breastfed infant.



Cough

For a dry cough, a cough suppressant such as dextromethorphan is considered safe while breastfeeding.

For a chesty cough, an expectorant such as guaifenesin or a mucolytic such as bromhexine may be used at the recommended dose.



Cold

Less sedating antihistamines, such as loratadine and cetirizine, can be used for short-term while breastfeeding for the relief of allergies and hay fever.

  • Sedating antihistamines are not recommended because the medicine may pass into your breast milk and make your baby drowsy.

Avoid oral decongestants such as pseudoephedrine or phenylephrine as they may reduce breast milk supply.



Heartburn

Oral antacids containing sodium, calcium, aluminium and magnesium are generally considered safe for use during breastfeeding.

  • Products containing alginates (e.g. the Gaviscon range) can be given during breastfeeding.
  • Due to lack of systemic absorption, simethicone is not expected to be present in breast milk.

All currently available H2 antagonists available OTC are considered safe to use during breastfeeding.

  • Cimetidine has extensive during interaction profile.

Limited information is available regarding the use of proton pump inhibitors during lactation, but small amount in milk is likely to be destroyed by acid in infant's stomach.



Constipation

After trying lifestyle changes (e.g. adding more fibre to diet, drinking plenty of water and exercise), osmotic laxatives such as lactulose or macrogol are safe to use at the recommended doses while breastfeeding.

Stimulant laxatives such as senna or bisacodyl may pass into the breast milk and cause diarrhoea in baby.



Diarrhoea

Oral rehydration solutions are recommended to replace the loss of fluid and electrolytes.

Loperamide may be used for one or two doses while breastfeeding to treat the symptoms of diarrhoea due to minimal oral absorption.

  • However, Lomotil (atropine and diphenoxylate) is not recommended during lactation.



Summary

The true need for any medication while breastfeeding should be carefully evaluated, as judicious use is essential to protect the infant.



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