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    Promoting Drug Safety During Breastfeeding

    Pharmacists can help women who breastfeed by identifying the safest drugs and dosage schedules to minimize exposure.


    Gastrointestinal Diseases

    Nonpharmacological intervention for nausea is preferred and includes practices such as smaller meals, a bland diet, and hydration. Antihistamines including meclizine, doxylamine, and diphenhydramine should be avoided because of the milk-supply-lowering anticholinergic effects.17,19 Occasional low doses of hydroxyzine are not likely to have any adverse effects on the infant. Limited data is available for metoclopramide, ondansetron, and phenothiazines. If these are used, the infant should be monitored for drowsiness.

    There are limited data about the use of simethicone for flatulence, but it is minimally absorbed.18 Loperamide for diarrhea is considered compatible with breastfeeding. Magnesium hydroxide (milk of magnesia), bisacodyl, and senna are preferred pharmacologic agents for constipation. 

    Calcium-containing products such as calcium carbonate are acceptable for gastroesophageal reflux disease in lactating women.19 Famotidine is preferred if an H2 antagonist is preferred for longer-term use because it is excreted in a smaller amount compared to other products in the class. Proton pump inhibitors such as 20 mg of esomeprazole and omeprazole or 40 mg of pantoprazole have not been shown to cause adverse effects in babies and are only slightly excreted in breastmilk. Use of sucralfate for peptic ulcer disease and gastroesophageal reflux disease is considered acceptable due to its low absorption potential.


    Pharmacists are well-positioned to influence new mothers to continue with breastfeeding. Patient education can include providing information on the benefits of breastfeeding, offering referral and education to address complications with lactation, selecting products to enhance nutrition in the breastfed infant, and identifying the safest drug selection and schedules to minimize infant exposure.  


    1. American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics 2012; 129(3) e827-e841.

    2. Centers for Disease Control and Prevention. Breastfeeding Report Card; 2016. Available at https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf. Accessed on Oct. 17. 2017/

    3. Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality. April 2007.

    4. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion Healthy People 2020. Available at https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infa.... Accessed on Aug. 1, 2017.

    5. U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Primary care interventions to support breastfeeding: U.S. Preventive Services Task Force recommendations statement. JAMA 2016;316:1688-93.

    6. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: Mothers‘ self-reported reasons for stopping during the first year. Pediatrics 2008; Oct;122, (Suppl 2):S69–S76.

    7. PL Detail-Document, Common breastfeeding complications. Pharmacist’s Letter/Prescriber’s Letter. December 2016.

    8. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk.Pediatrics 2001;108:776-89.

    9. Organization of Teratology Experts. Mother to baby. Available at https://mothertobaby.org/. Accessed on Aug. 1, 2017.

    10. Briggs, G., Freeman, R., Towers C., Forinash A. 2017 Drugs in Pregnancy And Lactation: A Reference Guide to Fetal and Neonatal Risk. Philadelphia, PA: Lippincott Williams & Wilkins.

    11. National institutes of Health. LactMed Database Available at https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm. Accessed on Aug. 1, 2017.

    12. Food and Drug Administration. Pregnancy and Lactation Labeling: Final Rule [cited 10/13/17]. Available from: https://www.fda.gov/drugs/developmentapprovalprocess/developmentresource...

    Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–104. DOI: http://dx.doi.org/10.15585/mmwr.rr6503a1

    13. Berens, P, Labbok, M, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. January 2015, 10(1): 3-12. https://doi.org/10.1089/bfm.2015.9999

    14. Clinical Resource. Analgesics in pregnancy and lactation. Pharmacist’s Letter/Prescriber’s Letter. June 2017.

    15. PL Detail-Document. Cough and cold meds in pregnancy and lactation. Pharmacist’s Letter/Prescriber’s Letter. November 2013.

    16. So M, Bozzo P, Inoue M, Einarson A. Safety of antihistamines during pregnancy and lactation. Canadian Family Physician. 2010;56(5):427-429.

    17. Centers for Disease Control [internet]. Breastfeeding and Vaccinations [accessed 8/1/17]. https://www.cdc.gov/breastfeeding/recommendations/vaccinations.htm

    18. PL Detail-Document, GI Med use in pregnancy and lactation. Pharmacist’s Letter/Prescriber’s Letter. June 2013.


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