The Breastfeeding Factor: Using Drugs While Breastfeeding
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It is common sense to avoid taking several medications at once while you are breastfeeding. If you use more than one medication at a time and your baby develops symptoms that you think might be related to the drugs, you will not be able to tell which drug is affecting her. Once you combine more than two drugs, the side effects can be unpredictable and may include problems not noted on a patient information insert. This applies to both pharmaceuticals and herbs, which can be as potent as drugs. Take any new drug or herb alone for the first few days to be certain that it isn't causing problems. Stick to the lowest possible effective dose and avoid extra-strength or long-acting medications. If possible, take medications after nursing or before your baby's longest period of sleep, so that your body has time to process the drug before the next feeding.
We have already discussed some of the possible dangers of selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Prozac, and Zoloft for nursing mothers. They may be linked to colic, and despite the fact that some are eliminated from the body more rapidly than others, they are all removed from the circulation relatively slowly. Because of the chemical composition of drugs that affect the central nervous system including SSRIs, other antidepressants, and antianxiety drugs they enter the milk in higher concentrations than other types of drugs. No research exists on the long-term nervous-system effects of these medications on babies exposed to them through their mothers' milk. Some medical organizations maintain that it is all right for nursing mothers to use SSRI antidepressants, and this approach is becoming an increasingly popular one for treating postpartum depression. We disagree. We feel that it is terribly premature and careless to widely prescribe these drugs at this time. However, there are exceptions. If you and your doctor perceive that you are in immediate and serious trouble and need quick short-term pharmaceutical help getting back on your feet, you don't necessarily have to stop breastfeeding. The benefits of nursing to your baby and to you probably outweigh the risks of exposing your baby to SSRIs for a few weeks. If you must take SSRIs, carefully watch your baby for any signs of increased sleepiness and consider stopping if your baby becomes so somnolent that you have to wake her up to nurse.
We advise against the use of low-dose minor tranquilizers, such as alprazolam (Xanax), in most cases. Very little is known about the effects they can have on a baby's developing nervous system, and they are addictive. There are many safe natural alternatives to these drugs that can help you relax during the day and sleep at night. Calcium and magnesium, taken at bedtime, can help relax your body into sleep. Mild to moderate exercise, meditation, yoga, and deep breathing are just as effective as minor tranquilizers. Herbs such as chamomile, passionflower, and valerian are safe natural relaxants that are safe for your baby.
Women who suffer from severe psychological disorders, such as suicidal depression, obsessive-compulsive disorder (OCD), or bipolar mood disorder (manic depression), may experience a worsening of their symptoms in the postpartum period. Such women may need medication. While research indicates that the drugs used for these disorders can be used during breastfeeding, there is no sure guarantee that they are completely safe. If you are extremely depressed, bipolar, or obsessive-compulsive, consult with your doctor and get a few other opinions before you give up on nursing your child. We also recommend that you read Dr. Andrew L. Stoll's book, The Omega-3 Connection (Simon & Schuster, 2002). Dr. Stoll has done extensive research on the use of omega-3 fats for the relief of bipolar disorder. Trying his plan is a no-risk, all-gain proposition that will actually benefit a breastfeeding baby.
Commonly used over-the-counter cough and cold medicines, decongestants, indigestion and diarrhea remedies, laxatives, and nonaspirin pain medications may not pose a significant danger to your nursing infant, but you probably don't really need to use them, either. In our culture, over-the-counter medications are considered to be utterly benign, but the truth is that every one of them has a long list of potential side effects, and they can be dangerous if several are taken in the wrong combination. Drugs are synthetic molecules not found in nature, and are usually harder on your detoxification systems than natural substances are. You should not be surprised if any of these drugs significantly diminishes your milk supply, either.
In most cases, you are better off finding a natural remedy for most of these complaints. Besides, such drugs provide only short-term treatment of symptoms. They do nothing to address the root issue. If you are generally healthy and well-nourished, you will not need any of these drugs.
If you do need over-the-counter temporary relief, stick with drugs that are used for babies as well as for adults. Check the shelf for baby versions of the drug you would like to use. Acetaminophen (in Tylenol and many other over-the-counter products) is your best bet for pain relief, although it is hard on the liver, so think twice or even three times before using it for yourself or your baby. Herbs and nutrients are better medicine than over-the-counter drugs for colds and most digestive complaints.
What if you are struck with an illness that requires antibiotic treatment? Monitor your baby carefully if you must use antibiotics. They may affect your baby's digestive function, causing diarrhea, constipation, or even colitis (a painful inflammation of the colon). If you or baby needs to take antibiotics, you can help to support baby's digestive health by giving him baby acidophilus powder. You can mix this into a bottle of expressed breastmilk or dab some onto your nipple before baby starts a nursing session. If you do need an antibiotic, your doctor will probably recommend an older drug, such as penicillin. Some women experience a decrease in milk supply with this medication.
Other drugs that are not completely off-limits during breastfeeding, but that require close observation of effects on baby's health, include the following:
- Barbiturates, a class of tranquilizer.
- Chlorpromazine (Thorazine), which is used to treat certain psychiatric disorders.
- Corticosteroids, such as prednisone (Deltasone), which are used for inflammatory conditions.
- Diuretics (water pills).
- Nalidixic acid (NegGram), an antibiotic sometimes used to treat urinary tract infections.
- Phenytoin (Dilantin), an antiseizure medication.
- Reserpine, which is used to lower blood pressure.
Even if you decide to bottle-feed, try to nurse your baby or pump your milk and feed it to your infant by bottle, if you'd rather for at least the first six weeks. This gives your baby the benefit of your immune factors, which can be indispensable in keeping him healthy during the early years of his life.
More on: Adjusting to New Motherhood
From A Natural Guide to Pregnancy and Postpartum Health by Dean Raffelock, Robert Rountree, and Virginia Hopkins with Melissa Block. Copyright © 2002 by Dr. Dean Raffelock. Used by arrangement with Avery, a member of Penguin Group (USA) Inc.
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