- They are commonly prescribed for infants. The amount the baby would get through the milk is much less than he would get if given directly.
- They are considered safe in pregnancy. This is not always true, since during the pregnancy, the mother's body is helping the baby's get rid of drug. Thus it is theoretically possible that toxic accumulation of the drug might occur during breastfeeding when it wouldn't during pregnancy (though this is probably rare). However, if the concern is for the baby's merely getting exposed to a drug, say an antidepressant, then the baby is getting exposed to much more drug at a more sensitive time during pregnancy than during breastfeeding.
- They are not absorbed from the stomach or intestines. These include many, but not all, drugs given by injection. Examples are gentamicin (and other drugs in this family of antibiotics), heparin, interferon, local anaesthetics, omperazole.
- They are not excreted into the milk. Some drugs are just too big to get into the milk. Examples are heparin, interferon, insulin.
The following are a few commonly used drugs considered 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, nonsteroidal antiinflammatory medications (such as ibuprofin), prednisone, thyroxin, propylthiourocil (PTU), warfarin, tricyclic antidepressants, sertraline (Zoloft), paroxetine (Paxil), other antidepressants, metronidazole (Flagyl), omperazole (Losec), Nix, Kwellada.
Note: Though generally safe, fluoxetine (Prozac) has a very long half life (stays in the body for a long time). Thus, a baby born to a mother on this drug during the pregnancy, will have large amounts in his body, and even the small amount added during breastfeeding may result in significant accumulation and side effects. These are rare, but have happened. There are two options that you might consider:
- Stop the fluoxetine (Prozac) for the last 4 to 8 weeks of your pregnancy. In this way, you will eliminate the drug from your body and so will the baby. Once the baby is born, he will be free of drug and the small amounts in the milk will not usually cause problems and you can restart the fluoxetine (Prozac).
- If it is not possible to stop fluoxetine (Prozac) during your pregnancy, consider changing to another drug which does not get into the milk in significant amounts once the baby is born. Two good choices are sertraline (Zoloft) and paroxetine (Paxil).
- Medications applied to the skin, inhaled (for example, drugs for asthma) or applied to the eyes or nose are almost always safe for breastfeeding.
- Drugs for local or regional anaesthesia are not absorbed from the baby's stomach and are safe. Drugs for general anaesthesia will get into the milk in only tiny amounts (like all drugs) and are extremely unlikely to cause any effects on your baby. They usually have very short half lives and are eliminated extremely rapidly from your body. You can breastfeed as soon as you are awake and up to it.
- Immunizations given to the mother do not require her to stop breastfeeding. On the contrary, the immunization will help the baby develop immunity to that immunization, if anything gets into the milk. In fact, most of the time nothing does get into the milk, except, possibly some of the live virus immunizations, such as German Measles. And that's good, not bad.
- X-rays and scans. Ordinary X-rays do not require a mother to stop breastfeeding even when used with contrast (example, intravenous pyelogram). The reason is that the material does not get into the milk, and even if it did it would not be absorbed by the baby. The same is true for CT scans and MRI scans. You do not have to stop for even a second.