Breastfeeding: Reducing risk

Last updated: Monday, March 14, 2016

The following points should be considered when advising on drug use in a breastfeeding mother:

  • If the drug is not essential it should be avoided or a non-pharmacological approach used instead.

  • There may be alternative drugs that are safer to use.

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  • The frequency of breastfeeding of babies varies a lot according to age. For example, a newly-born baby might feed every hour, whereas a one-year-old infant may be feeding only twice a day. This means it’s important to ask about the feeding regimen before suggesting how the administration of medicines might fit in. So, it would be pointless suggesting that a mother takes a long-acting medicine at bedtime to reduce infant exposure, if she feeds him throughout the night. 

  • Similarly, breastfeeding immediately before a dose, in an attempt to reduce exposure to peak plasma levels, is not often a practical option.

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  • For a very short course of treatment (less than 48 hours) breastfeeding could be interrupted temporarily, but longer interruption can make resumption difficult.

  • Not all mothers can cope with bottle-feeding (buying, measuring, sterilisation), in which case breastfeeding with limited infant exposure to a drug may be the most acceptable option.

  • As in any situation where the risk of side effects must be minimised: avoid multiple therapy where drugs have similar potential adverse reactions; use minimum doses and dosage forms that limit systemic exposure (e.g. inhalers); avoid new drugs and long-acting preparations if possible.

The UKMi specialist centres for medicines in breastfeeding offer additional guidance on safe use of medicines in breastfeeding here.