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Medications & Breastfeeding

You’ll notice that pretty much every medication on the market bares the warning “do not use if breastfeeding” or “consult your doctor if you are pregnant or breastfeeding.” This is often interpreted as “you can’t take this if you are pregnant or breastfeeding.” Actually, it means, “we are not liable for anything that happens to your baby if you take this drug while pregnant or breastfeeding.”
The MommyMeds App is published by Thomas Hale, the author of Medication and Mother’s Milk. I recommend providers have the Infant Risk App on their phone, while moms should have MommyMeds. I think these apps are the easiest to use and give the clearest answers on every and any drug in pregnancy and breastfeeding. All the information you see below is from the Infant Risk Database.

Medication safety in breastfeeding has its own scoring system:

L1- Safest

L2- Safer

L3- Moderately Safe

L4- Possibly Hazardous

L5- Contraindicated

Anything that is a L1 or an L2, feel free to take without concern. The pharmacokinetics of the drug (how it works in the body), tell us that it barely gets into milk or into the baby and there is adequate research on this drug in lactation to say there are no adverse effects in the breastfed baby.

Most of the good drugs are considered L3. Oftentimes, providers will say that any drug with an L3 rating is unsafe. This isn’t necessarily true. L3 is tricky. Anything that doesn’t have research on it automatically gets an L3 rating. If there are some studies that show minimal effects on babies, it will also get an L3 rating. A medication will also earn a L3 rating if it is detrimental to the milk supply, even if it is safe for the breastfed baby. Since it isn’t too ethical to test drugs on breastfeeding moms and babies, there are a lot of medications that don’t have research available on safety. That means that we need to look a little closer at L3 drugs. Since we know how medications get into milk, we can learn about if they are likely to be safe during breastfeeding.

Basically, anything with an L3 rating means, “weigh the risks and the benefits.”

Here are some awesome drugs you can take. This list is by no means all inclusive, just some of the most popular drugs out there.

These drugs are L1- Take them without any worry!

Ibuprofen (Motrin)
Acetaminophen (Tylenol)
Dextromethorphan (Robitussin)
Loratadine (Alavert, Claritin)
Sertraline (Zoloft)

L2- If you need, take it. It’s pretty safe.

Cetirizine (Zyrtec)
Caffeine (yup.)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Escitalopram (Lexapro)
Fluconazole (Diflucan)
Ondansetron (Zofran)
Loperimide (Imodium)
Docusate (Colace)
Bisacodyl (Ducolax)

L3- If you REALLY need it, you can probably take it!

Many of these, you just need to look at the details and make the best decision you can with your doctor. L3 medications are used in breastfeeding mothers all the time. For instance, the two most commonly prescribed drugs during the postpartum period are progestin only birth control and Percocet (most often post cesarean section). Both of these drugs are rated as L3.

Levonorgestrel is a progestin used in the Mirena IUD. Etonogestrel is a progestin used in the Nexplanon implant. Norethindrone is the progestin in Micronor. All three of these earn an L3 rating because small amounts of the hormone is shown to pass into breastmilk and into the breastfed baby. There are also anecdotal (ie not proven) reports that even progestin only birth control decreases milk supply.

Do not take estrogen containing hormones during lactation. That will almost certainly significantly decrease your milk supply. Progestin only, however, is pretty darn safe for the breastfeeding mom and baby.

Percocet also crosses to the baby, but is routinely prescribed to breastfeeding mothers when newborns are the most vulnerable.