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You Can Still Breastfeed
Written by Jack Newman, MD, FRCPC
Article appeared in July/Sept 1998 issue of "Keeping Abreast"

Over the years, many, many, many women have been wrongly told to stop breastfeeding.
The decision about continuing breastfeeding when the mother must take a drug, for example, involves more than consideration of whether the medication appears in the mother's milk. It also involves taking into consideration the risks of formula feeding for the baby, which are substantial, the risks of not breastfeeding for the mother, which are substantial, and other issues as well. For example, feeding a breastfeeding baby by bottle for the time the mother is on medication (rarely less than 5 days), will very often result in the baby refusing the breast forever or at least becoming very difficult on the breast.
On the other hand, it should be taken into consideration that some babies just will not take bottles, so the advice to stop is not only usually wrong, but impractical as well. Furthermore, it is easy to advise the mother to pump her milk when she is not feeding the baby, but adequate pumping is often very difficult to do for some mothers, with the result that the mothers may become very painfully engorged, which may further lead to serious complications.

Breastfeeding and Maternal Medication
Most drugs appear in the milk, but only in very tiny amounts. Although a very few drugs may still cause problems for infants even in tiny doses, this is not the case for the vast majority. Mothers who are told they must stop breastfeeding because of a certain drug should ask to be prescribed an alternative medication which is acceptable for breastfeeding mothers. In this day and age, it is rarely a problem to find such an alternative. If the prescribing physician does not know how to proceed, s/he should get more information. If the prescribing physician is not flexible, the mother should seek another opinion.

Most drugs may be considered safe for the mother to take and continue breastfeeding if:

1. they are commonly prescribed for infants. Examples are amoxycillin, cloxacillin, most antibiotics.
2. they are considered safe in pregnancy. Drugs enter directly into the baby's bloodstream when used during pregnancy. The baby generally gets much higher doses at a much more sensitive period during pregnancy, than during breastfeeding. This is not an absolute, however, as during pregnancy, the mother's liver and kidneys will get rid of the drug for the baby
3. they are not absorbed from the stomach or intestines. These include many drugs which are given by injection. Examples are gentamicin, heparin, lidocaine or other local anaesthetics used by dentists.
The following frequently used drugs are also generally safe during breastfeeding: acetaminophen (Tylenol, Tempra), alcohol (in reasonable amounts), aspirin (in usual doses, for short periods), most antiepileptic medications, most antihypertensive medications, tetracycline, codeine, most nonsteroidal antiinflammatory medications, prednisone, thyroxine, propylthiouracil (PTU), warfarin, tricyclic antidepressant medications, sertraline (Zoloft), paroxetine (Paxil), other antidepressants, metronidazole (Flagyl), Nix, Kwellada.
4. Medications applied to the skin, inhaled or applied to the eyes or nose are almost always safe for breastfeeding.
5. You can still breastfeed after general, regional or local anaesthesia. As soon as you are up to it. Medications you might take afterwards for pain are almost always permitted. Immunizations given to the mother do not require her to stop breastfeeding (including with live viruses such as german measles, Hepatitis A and B).
6. Get reliable information before stopping breastfeeding. Once you have stopped it may be very difficult to restart, especially if the baby is very young.

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Disclaimer: All material provided at is provided for educational and informational purposes only. Consult with your doctor regarding the advisability of any opinions or recommendations with respect to your individual situation.