Topic Overview

Prescription and non-prescription medications

Talk to your doctor before you take any prescription or non-prescription medicine while breastfeeding. Some medicines that enter the breast milk may harm your baby. But many medicines are safe to use while breastfeeding, including certain pain relievers, antibiotics, antidepressants, anticoagulants, and endocrine medicines (such as insulin).

Some medicines can harm your baby if taken while breastfeeding. These include pain medicines, such as codeine and tramadol, and some cough and cold medicines that may contain codeine. Most experts agree that you should not take tramadol while breastfeeding. They also agree that if you take codeine while breastfeeding, you should watch your baby very closely for signs that your baby is too sleepy. If your baby is not waking up or is not eating or drinking like usual, call your doctor or nurse call line right away.

Consider the following before taking medicines while breastfeeding:

• Use the safest medicine available. Some medicines have alternatives that are safer for breastfeeding mothers. Ask for the medicine that produces the lowest, safest levels of the drug in breast milk.
• Avoid using long-acting forms of non-prescription medicines. Medicine levels may build up quickly in the infant.
• Ask your doctor or pharmacist about the best time to take your medicine to minimize the effect on your baby. This is often just after a feeding.
• Watch for medicine side effects in your infant. Tell your doctor about any fussiness, rash, changes in feeding or sleeping patterns, or other concerns.

Talk to your doctor about temporarily discontinuing breastfeeding if you must take a medicine that is not safe for your baby. If you are going to take this medicine in a single dose or for a relatively short time (1 or 2 weeks), bottle-feed formula to your baby, but keep up your milk supply by pumping your breasts and discarding the milk. When the medicine has left your system, you can go back to breastfeeding your baby.

Alternative remedies

Domperidone is a prescription medicine available in Canada to treat gastric disorders. It is sometimes prescribed to breastfeeding women to increase their milk supply. Domperidone increases milk supply by stimulating the production of the hormone prolactin. The drug's effect on breastfeeding infants is unknown.^{footnote 1}

Some breastfeeding women try herbal remedies for problems, such as to increase milk supply. Common herbs used for these purposes include fenugreek, fennel, or various herbal teas. As with any medicines, do not take herbs without first talking with your doctor. The effects of most herbal remedies on babies are unknown. Some experts advise that some herbs (including fenugreek, fennel, comfrey leaf, and borage) may harm the baby. Herbs may also cause allergic reactions in the mother or the baby.

With herbal teas or preparations, even more caution is needed, because the strength of an herbal tea or product depends upon how it is prepared. The actual amount of an herb consumed is very hard to predict or study.