New Guidelines on Medication Safety for Breastfeeding Mothers

AAP advice on specific medications

• Antianxiety drugs, antidepressants, and mood stabilizers – Information on the long-term effects of these medications is still limited, and data is not available for up to one-third of mental-health medications, so they should be taken with caution. (Medications that have shown up in "clinically significant" levels in breastfed infants' bloodstreams include bupropion, diazepam, fluexotine, citalopram, lithium, lamotrigine, and venlafaxine.)
• Drugs for smoking cessation – Nicotine gum or lozenges are the preferred forms of smoking-cessation aids as long as the prescribed level of nicotine in the therapy used is less than the nicotine level in the number cigarettes the mother would smoke. The FDA discourages the use of bupropion (brand names include Aplenzin, Wellbutrin, and Zyban) and varenicline (brand name Chantix) in lactating women.
• Narcotic pain medications – Exercise caution with codeine and hydrocodone, watching for any effects on the nursing mother or infant. Oxycodone, pentazocine, propoxyphene, and meperidene are not recommended for nursing mothers. Some other narcotics are acceptable but should be used at the lowest dose for the shortest duration of time. Check the LactMed database for more information on pain medication safety.
• Non-narcotic pain medications – When over-the-counter pain relievers are adequate for pain mananagement, ibuprofen (brand names include Advil, Midol, Motrin) and acetaminophen (brand name Tylenol), are acceptable. Low doses of aspirin may also be acceptable. However, there is limited data on other NSAID pain relievers, so the FDA discourages their use by lactating women.
• Galactogogues (agents used to stimulate lactation, often in mothers of preterm infants or in adoptive mothers who wish to breastfeed) – These have a limited role in helping women lactate, and their effects on nursing infants have not been thoroughly studied. The AAP advises consulting a lactation specialist for assistance rather than using these drugs.
• Herbal products and dietary supplements – The use of the following herbs is not advised: kava, yohimbe, chamomile, black cohosh, blue cohosh, chastetree, echinacea, ginseng, gingko, Hypericum (St. John's wort), and valerian. Vitamins and iron supplements are safe for most nursing moms as long as recommended daily allowances are not exceeded, but the use of other nutritional supplements may not be safe because it is possible to "overdose" on certain vitamins and minerals.
• Radiopharmaceuticals (diagnostic imaging substances) – If possible, elective diagnostic imaging procedures should be delayed until a woman is no longer breastfeeding. Consult a radiologist for more information.
• Oncologic drugs (cancer treatment medications) – Cancer treatment may require multiple therapies that preclude women from breastfeeding. Consult an oncologist or specialist for more information.

One major rule hasn't changed: Breastfeeding women should consult their physician before taking any new type of prescription or over-the-counter medication, herbal remedy, or dietary supplement. The AAP report states that most maternal vaccines are safe for breastfeeding mothers and their infants, but women should still check with their doctor before getting immunizations.

The primary goal of these new AAP guidelines is to avoid the unnecessary restriction from breastfeeding for women who wish to do so. Keep open lines of communication with your doctor when it comes to medication use, and, in most cases, your baby will thrive on the hard-to-beat antibodies and nutrients of breast milk.