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5 August, 2019 00:00 00 AM

Breastfeeding and medication

AsiaMed Connect
Breastfeeding and medication

The advantages of breastfeeding for both a mother and her baby are well known. Many nursing mothers may need to be treated with drugs, either for a chronic illness requiring ongoing therapy or for an acute illness requiring only a few days therapy. Unfortunately, nursing mothers are often discouraged from breastfeeding by the belief that the suckling child will suffer adverse effects from the drugs in the milk.

The safety of breastfeeding while a mother is taking medication may be assessed by weighing the risks of adverse effects occurring in the baby due to the drug, against the beneficial effects of the drug for the mother. The benefits to the baby of breastfeeding must also be considered.

How to reduce drug transfer to the infant

Methods of minimising drug transfer to the infant include:

Using an alternative route of administration. e.g use a nasal spray instead of oral bronchodilator

Using the lowest appropriate dose

Timing the feed to minimise the amount of drug in milk. e.g. taking maternal dose immediately after a feed, or before babies longest sleep period

Choosing an alternative drug therapy if possible

Expressing and discarding milk if drug treatment is only short-term so that the milk supply does not stop while the baby is being given an alternative source of nutrition such as formula.

Drugs contraindicated in breastfeeding

Most drugs are transferred to breast milk only in small amounts and the dose to which the infant is exposed is very low and well below the therapeutic dose for an infant. However, all infants exposed to drugs via breast milk should be observed for drug-related side effects.

Drugs which are considered unsuitable for use by breastfeeding mothers include: amiodarone, cytotoxic agents, lithium, radio pharmaceuticals, and retinoids.

Commonly used Medications during breastfeeding

Analgesics - aches and pain

The drugs ibuprofen, diclofenac, indomethacin and naproxen have an acceptably low infant dose and are considered safe to use. Aspirin is contraindicated only because of the theoretical risk of Reye's syndrome.

Both paracetamol and codeine are safe alternatives, although combinations containing codeine 30mg should be used cautiously.

Anthelmintics - worms

Pyrantel and mebendazole are considered safe as they are poorly absorbed from the gastrointestinal tract and are unlikely to be transferred to breast milk in clinically significant amounts.

Cold and Flu

Nasal symptoms-Steams inhalations and saline (sodium chloride) nasal spray may provide symptomatic relief. Decongestant nasal sprays (oxymetazoline, xylometazoline) may be used. However, oral preparations containing pseudoephedrine should be avoided as it may reduce milk production, and may cause irritability in a breastfed baby.

Cough- Usually self-limiting. If treatment is required, use guaifenesin, bromhexine or senega and ammonia mixture for chesty cough; pholcodine or dextromethorphan for dry cough. Avoid combination preparations with pseudoephedrine.

Sore throat -Lozenges or throat gargles containing amylmetacresol, dichlorobenzyl alcohol or cetylpyridinium may be used. Avoid products containing iodine.

Antihistamines; allergies and hayfever- Sedating antihistamines such as dexchlorpheniramine or diphenhydramine may be used but the baby should be observed for sedation or irritability. Of the non-sedating antihistamines, loratadine and desloratadine are transferred into breast milk in very small amounts and are considered safe. Fexofenadine and cetirizine should be avoided as they have not been studied.

Nasal sprays containing beclomethasone, fluticasone or budesonide may be used while breastfeeding. Eye drops containing antazoline and naphazoline are considered safe to use.

Anti-infectives

In general, these drugs have the potential to cause changes in bowel flora and infants should be observed for adverse

gastrointestinal effects such as diarrhoea and thrush.

Penicillins (amoxycillin, flucloxacillin), cephalosporins (cephalexin),  and macrolides (erythromycin and roxythromycin) are considered safe.

Metronidazole is considered safe in doses up to 400mg three times a day, although it may give the milk a bitter taste. With a single high dose of metronidazole, milk should be expressed and discarded for 24 hours after the dose.

Head Lice

Non-insecticidal treatment - 10 Days Hair Conditioner Method: Apply plenty of hair conditioner to the dry hair until saturated, use ordinary comb to remove tangles, then use metal fine tooth nit comb in 4 directions (forward, backward, left and right). Remove lice from comb. Rinse out and dry hair. Repeat daily for 10 days.

Insecticidal treatment - Permethrin, pyrethrin or piperonyl butoxide may be used. Wash off before feeding.

Antidepressants

Some antidepressants are considered compatible with breastfeeding. Talk to your doctor or pharmacist to discuss your options and for further advice.

Herbal preparations

There is very little information available on the distribution of herbal preparations into breast milk, or their effects on lactation. Care should be exercised with their use.

Oral contraceptives

The progesterone-only "minipill" is the preferred oral contraceptive for breastfeeding women as transfer to milk is minimal and lactation is not affected.

The combined oestrogen-progesterone pill may decrease the quantity and alter the composition of milk. (Reprint)

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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