Have you ever been told that you needed to pump and discard your milk because you've taken medication? Read on to see if this is always necessary, or whether that liquid gold can be saved.
Can medications really transfer to your breast milk?
The short answer is yes.
The long answer is a bit more complicated, as not all medications/drugs are created equal when it comes to breastfeeding.
There are a variety of factors to consider when trying to determine whether a particular medication is compatible with breastfeeding, including (but not limited to): are there any published studies (on either lactation or effects on the breastfed infant), drug oral bioavailability, relative infant dose, molecular weight, protein binding, and half life.
Any time that you take any drug or supplement, you are making a cost-benefit analysis. That is, will the benefits of taking this drug outweigh any potential risk? The same is true for breastfeeding dyads. Your healthcare team should always ask the question - do the benefits of this drug outweigh the risk to the breastfed infant? Do the risks to the breastfed infant by ingesting this drug second-hand outweigh the risks of interrupting the breastfeeding relationship (even temporarily)?
Some drugs pass freely into milk and have been known to have an effect on breastfed infants, but many drugs are not considered dangerous. This may be because they pass into milk in only very small amounts, the drugs are not well absorbed by infants, the drugs are eliminated from the mother's system very quickly, or because the drugs are not considered harmful to infants even when given directly.
You might be surprised to learn, in fact, that there are not many drugs which are considered strictly incompatible with breastfeeding and which absolutely necessitate either "pumping and dumping" milk or weaning a breastfed child.
How do I know which drugs are compatible with breastfeeding and which are not?
The first step in considering whether a drug is compatible with breastfeeding would be to speak to your doctor, midwife, and/or pharmacist. Not all healthcare providers are knowledgeable on breastfeeding medicine, however, and the following are good additional resources:
InfantRisk Centre. The InfantRisk Center (IRC) is a world-wide call center presently in the Texas Tech University Health Sciences Center, School of Medicine, Department of Pediatrics, in Amarillo. InfantRisk maintains an extensive database of drug information and how they relate to safety during pregnancy and lactation. You can call them for free anywhere in the world to speak to an agent about a specific drug or drug combination. You can also access their database through their mobile app with a paid subscription.
LactMed. LactMed is another popular database often used by healthcare professionals to determine whether a drug is compatible with breastfeeding. Articles are informative and accessible for free by anyone through their website. Unfortunately, LactMed is no longer updated so all information should be used with caution.
International Board Certified Lactation Consultant (IBCLC). It is within the IBCLC's scope of practice to provide patients with evidence-based information regarding the safety of drugs while breastfeeding. Although IBCLC's cannot prescribe medications, they are an excellent resource for lactation-related drug safety questions.
The take away
Most drugs do not require you to pump and dump your breast milk, but there are many factors to consider. If in doubt, reach out to an IBCLC for help!
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