Breastfeeding

• Prescribing principles for medicines use in breastfeeding

  • Continue medicines taken during pregnancy, but check safety in breastfeeding
  • Avoid unnecessary drug use, use non-pharmacological and lifestyle measures first
  • Assess benefit/risk ratio for both mother and infant
  • Avoid drugs known to cause serious toxicity in adults or children
  • Drugs licensed for use in infants generally pose no hazard
  • Choose regimen and route that minimises drug exposure to infant
  • Avoid long-acting preparations
  • Monitor infants for unusual signs or symptoms
  • Avoid new drugs if a therapeutically equivalent alternative is available
• Preferred medicines for breastfeeding

  • Drugs with short half-lives, high protein binding, low oral bioavailability and high molecular weight
  • Consider age and weight of infant
  • Medicines safe for infants are generally safe for breastfeeding women
  • Medicines with long-term clinical experience are generally preferred
  • Lithium is contraindicated in breastfeeding
• Inferring potential for harm to infant

  From pharmacokinetic characteristics of drug in mother, infant pharmacokinetics, and pharmacodynamic properties of drug in infant
• SPC, UKDILAS provide information for breastfeeding women
• Asthma medicines safe in breastfeeding

  • Salbutamol, terbutaline, salmeterol inhalers
  • Inhaled steroids
  • Oral corticosteroids
  • Theophylline may cause toxicity in younger infants, seek specialist advice
  • Limited evidence on safety of leukotriene receptor antagonists, but very low levels in breastmilk
  • Long-acting β2 agonists should be used with inhaled steroids
• Depression medicines safe in breastfeeding


  • Sertraline or paroxetine preferred
  • No need to change from stabilised drug, monitor infant for drowsiness, poor feeding, irritability, or behavioural effects
• Diabetes medicines safe in breastfeeding

  • Insulin
  • Metformin
  • Glibenclamide
  • Limited information on other oral antidiabetic drugs, refer to resources
  • Statins not recommended
• Epilepsy medicines safe in breastfeeding

  • All mothers should be encouraged to breastfeed with support from mid-wife and GP
  • Parents should be aware of signs of toxicity in infants
  • Consider possibility of sedation with high dose AEDs, polytherapy, or regimen with levetiracetam , gabapentin, lamotrigine and topiramate.
• Hypertension medicines safe in breastfeeding

  • Diuretics should be avoided
  • Labetalol, atenolol, metoprolol, nifedipine, enalapril, captopril considered safe
  • Less safety information on angiotensin antagonists, amlodipine, other ACE inhibitors
  • Assess infant feeding adequacy, at least daily for first 2 days
• Hypothyroidism medicine safe in breastfeeding

  • Levothyroxine is safe, dose should be increased at pregnancy confirmation and check TSH and FT4 levels
  • Certain drugs, especially iron, disturb absorption of levothyroxine