The Breastfeeding Factor: Using Drugs While Breastfeeding

Drugs that May Be Unsafe
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.

If you find yourself needing to take medication and are faced with admonitions from your doctor to wean your baby as a result, call your local La Leche League leader. This organization keeps up-to-date drug information that will help you to make the right choice for you and your baby. It is possible that you may come to the conclusion that nursing simply isn't possible for you. It's true that some women simply cannot breastfeed for valid medical reasons. It is your decision, after all, and only you can make it. You can still have a wonderful, nurturing relationship with your baby – it just may take a bit more effort on your part. Fortunately, too, formulas are getting better all the time. American formula manufacturers are beginning to put the omega-3 fat docosahexaenoic acid (DHA) into their products (years after European companies mandated its addition), and finding a formula with DHA in it is easier than it has ever been. For excellent information on bottle-feeding, we recommend the books on baby care and breastfeeding by pediatrician William Sears, M.D.

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.