Introduction
Certain drugs, if taken by mothers while breastfeeding, may cause adverse effects on children because of their ability to pass through the breastmilk. This information confuses many breastfeeding mothers who take medication and may put them in a dilemma about whether to breastfeed or not. Many mothers receive incorrect advice to stop nursing or to stop taking necessary drugs out of concern for potential negative consequences on their babies. Because only a tiny percentage of drugs are contraindicated in breastfeeding mothers or linked to harmful effects on their infants, this cautious approach may not always be essential.
Which Drugs Are Transferred Into Breast Milk?
Numerous antidepressants, mood stabilizers, and anti-anxiety medications are found in low amounts in human milk, with estimated relative newborn doses of less than 2 % of weight-adjusted mother dose and/or milk-plasma ratios of less than 1. It has been noted that Bupropion, Diazepam, Fluoxetine, Citalopram, Lithium, Lamotrigine, and Venlafaxine have maternal dosage percentages close to clinically significant levels. Nursing infants may have detectable levels of the drug or its metabolites in plasma and possibly in neural tissue due to the prolonged half-lives of some of these substances and/or their metabolites, as well as an infant's undeveloped hepatic and renal function.
Several selective serotonin reuptake inhibitors, antipsychotics, anxiolytics, and mood stabilizers have been documented to have infant plasma concentrations that are greater than 10 % of therapeutic maternal plasma concentrations. Psychoactive medications exceeding 10 % of maternal plasma concentrations in infant serum include Diazepam, Lithium, Doxepin, Lamotrigine, Mirtazapine, Olanzapine, etc.
Little information is available on drug usage in lactating women to treat alcoholism and drug misuse or to help them quit smoking. However, certain habits, like continuing to consume alcohol or illegal drugs, and underlying diseases, like HIV (human immunodeficiency virus) infection, are incompatible with nursing.
The FDA (Food and Drug Administration) has given Methadone, Buprenorphine, and Naltrexone approval for treating opioid dependence. Women receiving such therapy can continue breastfeeding if they abstain from drug use, are HIV-negative, are enrolled in and receive careful monitoring from a suitable drug treatment program, and have strong social support.
What Are the Adverse Effects Caused by the Drugs Transferred Through Breast Milk in Infants?
Following are the drugs that are passed through breast milk and their adverse effects on infants:
-
Amphetamines: They are a group of synthetic drugs that are strong central nervous stimulants. Amphetamines are used to treat attention deficit hyperactivity disorder (ADHD), obesity, and narcolepsy (a neurological condition that reduces a person's ability to regulate sleep). Long-term behavioral consequences, such as learning and memory deficiencies and altered locomotor activity, were seen in animal studies of postnatal exposure. Infants breastfed by mothers who take amphetamines may develop hypertension, tachycardia (regular or irregular rapid heart rate), and seizures.
-
Benzodiazepines: They are a group of antidepressants that are used to treat anxiety, depression, insomnia, etc. In neonates or premature infants, accumulation of metabolites and extended half-lives are observed. Symptoms in infants include apnea, cyanosis, sedation, and seizures.
-
Cocaine: It is a central nervous stimulant that is used illegally due to its euphoric and rewarding effect. If a breastfeeding mother takes cocaine, it can cause intoxication, seizures, irritability, diarrhea, vomiting, etc.
-
Heroin: It is a naturally occurring, highly addictive drug that is used illegally. In infants, it can cause tremors, vomiting, restlessness, and difficulty feeding.
-
Alcohol: Alcohol intake during the breastfeeding period by the mother can cause problems in motor development, reduced milk consumption, and sleep disturbances.
What Medications Are Considered Safe For Breastfeeding Mothers?
The following medications are considered safe during breastfeeding:
1. Pain Relievers or Analgesics: Medications that are used to reduce pain and inflammation.
-
Ibuprofen.
-
Naproxen.
2. Antimicrobial Medications: Medication used for killing or stopping the growth of disease causing microbes.
-
Miconazole.
-
Fluconazole.
-
Clotrimazole.
-
Penicillin.
-
Cephalosporin.
3. Antihistamines: Medications used for treating allergies, rhinitis, cold, and influenza.
-
Fexofenadine.
-
Loratadine.
4. Decongestants: Medications used to relieve the symptoms of congested or stuffy nose due to the infection in the upper respiratory tract.
-
Sudafed.
-
Zyrtec.
5. Gastrointestinal Medications: Medications used to treat any disorder or infection in the gastrointestinal tract.
-
Famotidine.
6. Antidepressants: These are the medications used to reduce the symptoms of depression, anxiety, and insomnia.
-
Paroxetine.
-
Sertraline.
-
Fluvoxamine.
7. Birth Control: Pills which are used to stop the release of eggs from ovaries to prevent pregnancy.
-
Progestin.
-
Combination of estrogen and progesterone.
8. Laxative: Medicines used to loosen the stools, improve bowel movement, and hence to evacuate the bowel are called laxatives. These are used to treat constipation.
-
Docusate.
Should Mothers Stop Taking Medications While Breastfeeding?
The majority of drugs are safe to take during nursing. Additionally, the advantages of continuing treatment for a chronic ailment may outweigh any dangers. However, some drugs should not be used while nursing. The doctors might suggest a different medicine if the mother is using one that might harm their unborn child. When the medicine is present in your breast milk in only little amounts, they could advise nursing.
The doctors could occasionally advise mothers to quit nursing temporarily or permanently. The advice may change depending on how long they must take the medication. They can pump in addition to nursing and storing expressed milk in advance. Once mothers start taking the medication, they can use the breast milk that has been saved. If they just need to temporarily cease breastfeeding, they can use a double electric breast pump to maintain milk production until they can resume breastfeeding. While taking the drug, people can toss the milk they pump.
Conclusion
Certain medications can pass through the breast milk. This information makes many mothers extremely cautious, and they may stop breastfeeding temporarily or permanently to avoid any complications for their infants. But this causes infants not to get any benefits of breastfeeding. Mothers are advised to inform their doctors about breastfeeding and the age of the child when they are prescribed medications. This can avoid many complications to an extent.
