Key takeaways: Most medicines are compatible with breastfeeding, and stopping breastfeeding is rarely necessary. Use trusted sources like LactMed and MotherToBaby. Your baby’s age and health matter. Always tell your providers you’re breastfeeding.
Many parents are told to “pump and dump” or stop breastfeeding when they need a medication. In most cases, that advice isn’t necessary. Here’s how to check safety and make informed decisions.
How Medicines Get Into Breast Milk
Most medicines pass into breast milk in small amounts. How much reaches your baby depends on:
- The medicine’s properties: size, how much binds to proteins in your blood, how fat-soluble it is.
- How much reaches your bloodstream in the first place (some medicines, like many creams, inhaled medicines, or local anesthetics, barely do).
- How much your baby absorbs from their gut.
- Your baby’s age and health: newborns and premature babies clear medicines more slowly.
For most medicines, the amount a baby receives is a small fraction of the parent’s dose.
Trusted Sources
- LactMed (Drugs and Lactation Database): a free, evidence-based database from the National Institutes of Health, also available as an app.
- MotherToBaby: free information by phone, text, chat, or email from specialists.
- InfantRisk Center at Texas Tech University: a call center for parents and providers.
- Your pharmacist, pediatrician, OB, and lactation consultant.
The information on medication package inserts is often very conservative and may not reflect current evidence about breastfeeding.
Common Medicines That Are Usually Compatible
These are generally considered compatible with breastfeeding in typical doses (always confirm for your situation):
- Pain relievers: acetaminophen and ibuprofen.
- Many antibiotics: such as penicillins and cephalosporins.
- Many antidepressants: including several SSRIs such as sertraline.
- Thyroid medicine: levothyroxine.
- Many allergy medicines: loratadine and cetirizine (some sedating antihistamines may make babies sleepy).
- Most vaccines, including flu, COVID-19, and Tdap.
- Many birth control methods, especially progestin-only options. Estrogen-containing methods may lower supply in some people, especially early on.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. If you want feeding help you can flip to in the middle of the night, my book walks you through feeding month by month, from the very first latch to the first birthday.
Medicines That Need Extra Caution
- Codeine and tramadol: not recommended; some people convert them into high levels of active drug.
- Decongestants such as pseudoephedrine: may reduce milk supply.
- Some chemotherapy and radioactive medicines: usually require stopping or pausing breastfeeding.
- Certain sedatives, opioids, or high-dose medicines: need individualized decisions and monitoring of your baby.
Questions to Ask Your Provider
- Is this medicine compatible with breastfeeding?
- Is there an alternative with more safety data?
- Should I time doses around feeds?
- What signs should I watch for in my baby?
- Does this affect milk supply?
Alcohol, Cannabis, and Nicotine
- Alcohol: not drinking is safest. If you do drink, the CDC says moderate drinking (up to one standard drink a day) isn’t known to be harmful, especially if you wait at least 2 hours after a drink before nursing. Alcohol leaves milk as it leaves your blood; pumping and dumping doesn’t speed this up.
- Cannabis: THC passes into breast milk and can stay for days to weeks. The AAP and ACOG advise against cannabis use while breastfeeding.
- Nicotine and smoking: smoking reduces supply and exposes babies to smoke. If you smoke or vape, breastfeeding still offers benefits, but quitting is best. Never smoke around your baby.
Herbal Supplements
“Natural” doesn’t always mean safe. Many herbs haven’t been well studied in breastfeeding. Check LactMed and talk with your provider before using them.
Call your baby’s doctor if your baby: is unusually sleepy, hard to wake, feeding poorly, has trouble breathing, or seems unusually irritable after you’ve started a new medicine.
The Bottom Line
Most medicines are compatible with breastfeeding. Check reliable sources like LactMed, tell every provider you’re breastfeeding, and ask about alternatives if needed. You rarely have to choose between your health and breastfeeding.
For a complete guide to the first year, see my book, From First Breath to First Birthday.
Related Articles
- Breastfeeding When You’re Sick
- Fever in a Newborn: Why 100.4°F Means Call Right Away
- Secondhand and Thirdhand Smoke
Sources
- Drugs and Lactation Database (LactMed). National Institute of Child Health and Human Development. https://www.ncbi.nlm.nih.gov/books/NBK501922/
- Sachs HC; Committee on Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796-e809.
- MotherToBaby, Organization of Teratology Information Specialists. https://mothertobaby.org
- Centers for Disease Control and Prevention. Alcohol and breastfeeding. https://www.cdc.gov/breastfeeding
- Ryan SA, Ammerman SD, O’Connor ME; Committee on Substance Use and Prevention; Section on Breastfeeding. Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes. Pediatrics. 2018;142(3):e20181889.
- US Food and Drug Administration. FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. April 2017. https://www.fda.gov
- Meek JY, Noble L; Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022;150(1):e2022057988.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
