What Can I Take While Lactating?

Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) are considered safe to take when lactating.

Naprosyn (Aleve, Naproxen) is considered safe to take when lactating. If possible, choose acetaminophen or ibuprofen first because Naprosyn stays in your body longer.

Oxycodone, hydrocodone, or other prescription medicines sometimes given after childbirth or cesarean section are considered safe to take when lactating, for short term use. The benefits of taking these medicines usually outweigh any potential effects on your baby. These medicines can make your baby drowsy, so it is best to take it after you feed your baby or pump.

Long term, chronic use of pain medicines should be monitored closely by a chronic pain doctor who is familiar with lactation.

Generally, these medications are safe to take when you are lactating. However, some diuretics may affect milk supply more than others. If you are struggling with low milk supply while on a diuretic, ask your provider if there are other options.

Both hormonal and non-hormonal types of birth control are safe when you are lactating, but some hormonal types may reduce how much milk you make. To be cautious, some experts recommend waiting to start estrogen or progesterone birth control until after your milk supply is well established (about 4 weeks after birth).

Types of Birth Control

Please talk with your health care provider about family planning.

Check the active ingredients carefully before taking any cold medicine.

It is safe to take most cold medicines while you are lactating. However, cold medicines containing the decongestant pseudoephedrine may reduce your milk supply. Nasal sprays are an alternative that would not impact milk supply.

Some cold medicines have antihistamines. There are 2 types of antihistamines: a type that make you sleepy (sedating) and a type that do not (non-sedating).

Sedating

• Benadryl (Diphenhydramine)
• Chlor-Trimeton (chlorpheniramine maleate) 

Non-sedating

• Claritin (loratadine), Claritin-D (loratadine/pseudoephedrine)
• Clarinex (desloratadine), Clarinex D (desloratadine/pseudoephedrine)
• Allegra (fexofenadine), Allegra-D (fexofenadine/pseudoephedrine)
• Zyrtec (cetirizine hydrochloride) 

Non-sedating is generally preferred, though it may reduce your milk supply. You and your baby may be sleepier if you choose the sedating type.

If you are on methadone or buprenorphine maintenance therapy and followed by a medical provider, it is safe to breastfeed/chestfeed or pump for your baby and may reduce NOWS (neonatal opiate withdrawal syndrome) if you were on these medications during pregnancy.

Make sure your provider knows that you are lactating. Usually, you can restart providing your milk for your baby as soon as you have recovered enough from anesthesia. You do not need to throw away any milk after anesthesia, as only a small amount of the medicine used to make you sleep enters your milk and even less is absorbed by the baby.

Local and dental anesthetics

If you have numbing medicine (anesthetics) for medical procedures or dental work, it is usually still OK to provide your milk for your baby. Check with your provider to make sure.

The American College of Radiology has a policy that states a lactating parent may continue to provide milk after receiving a contrast dye.

Caffeine is found in coffee, tea, energy drinks, chocolate and many sodas. Since only a small amount of caffeine enters your milk, about 300 milligrams (mg) per day is considered safe when you are lactating.

There are about 175 mg of caffeine in 8 ounces of brewed coffee (a small or a “short” at Starbucks). However, a large or “venti” brewed coffee has 410 mg. The caffeine in your milk is highest 1 to 2 hours after you consume it.

What if I have more than 300mg per day of caffeine?

If you have more than 300mg of caffeine per day, feed your baby or pump right before having the caffeine. This allows your body time to process the caffeine before you are due to feed or pump again.

Younger and more fragile babies may be more sensitive to caffeine because it takes their bodies longer to process caffeine. It is rare, but possible, for infants to have sleeping problems and more fussiness after a lactating parent has had heavy caffeine use (8 servings or 1200 mg per day).

If you take herbal medicines or supplements, it is still safe to provide your milk for your baby in most cases. Check with your healthcare provider or lactation consultant for the most complete list and latest information on safety.

Avoid these herbal medicines:

• Blue Cohosh
• Comfrey
• Ginseng
• Goldenseal
• Kava Kava
• Licorice
• Mate or yerba mate tea
• Mint
• Sage
• Senna

Alcohol use during lactation is not recommended, but if you do drink, drink in limited amounts, and follow these guidelines. If you use alcohol daily, it is best to reduce your use or consider that it may be best not to lactate at all. Talk to your healthcare provider and discuss resources to help you decrease or stop using alcohol.

Some facts we know:

• There is no known safe level of alcohol for a baby.

Before drinking 

• Breastfeed/chestfeed or pump right before having alcohol. This allows your body time to process the alcohol before you are due to feed or pump again.
• Store previously pumped milk or formula for use after moderate or heavy drinking.
• Eat before and while drinking alcohol. 
• Make sure your baby is being cared for by someone not under the influence of alcohol.

After drinking

If you feel the effects of alcohol (feeling “tipsy” or “woozy” or drunk), wait 2 hours to feed your baby from your breast/chest.

• Pump and dump your milk if you feel the effects of alcohol.
• Make sure your baby is not sleeping on the same surface as or sharing a bed with anyone under the influence of alcohol.
• For more individualized assessment of how long you need to wait after drinking to feed your baby, see the InfantRisk Center calculator.
  infantrisk.com/content/alcohol-breastfeeding-whats-your-time-zero

Marijuana use during lactation is not recommended, but if you do use it occasionally, choose limited amounts, and follow these guidelines. If you use marijuana daily, it is best to reduce your use and THC concentration or consider that it may be best not to lactate at all. Talk to your healthcare provider and discuss resources to help you decrease or stop using marijuana.

Some facts we know: 

• THC (tetrahydrocannabinol) is the chemical in marijuana that makes you feel “high.” This chemical passes to your baby during pregnancy and during breastfeeding/chestfeeding and is stored in your baby’s fatty tissue for several weeks. Babies have a high percentage of body fat, especially in their developing brain.
• There are not adequate studies to say how much marijuana is safe and at what point it becomes harmful to your baby. Some studies show that THC exposure in babies during pregnancy may affect their ability to learn and focus later in life.
• Because THC stays in the body so long, pumping and discarding your milk is not a useful way to clear your milk of THC if you use frequently. With occasional use with smoked marijuana, THC levels are highest in the first hour after using.
• If you do use marijuana while lactating, try to choose a product that has as low of a THC concentration as possible.
• Marijuana products (weed, joints, hash, tinctures, sprays, oils and edibles, such as cookies or brownies with marijuana added) can have a very high concentration of THC. Keep all marijuana products locked up and away from children.
• Edibles have higher potency and vaping products are less regulated. Consider avoiding edibles & vaping. There is almost nothing known about how much THC or cannabis enters breastmilk/chestmilk after using edibles.

Before Using Marijuana

• If you smoke marijuana only occasionally, breastfeed/chestfeed or pump right before smoking. This allows your body time to process the THC before you are due to feed or pump.
• Store previously pumped milk or formula for use while using marijuana. • Make sure your baby is being cared for by someone not under the influence.
• Do not smoke or let anyone else smoke marijuana around your baby. Secondhand smoke is not good for your baby and your baby will be exposed by inhaling the smoke.
• If smoking, wear something over your clothes and hair that you can remove when you go back to your baby.

After Using Marijuana

• Change clothing and wash your hands and face after smoking.
• With occasional use, wait 2 or ideally 3 hours to breastfeed/chestfeed or pump again.
• Make sure your baby is not sleeping on the same surface as or sharing a bed with anyone who has been smoking marijuana.

Dronabinaol (Marinol)
If you take medical marijuana in the form of dronabinaol (Marinol):

• Long term, chronic use of this medicine may not be recommended when breastfeeding/chestfeeding or pumping.
• Short term use in small doses determined by your provider may be safer when breastfeeding/chestfeeding because there is less THC exposure to your baby than a marijuana cigarette.

Tobacco use is not recommended during lactation, but if you do use tobacco products, limit your use as much as possible.

Some facts we know:

• Nicotine transfers into your milk.
• Your milk helps protect your baby from the effects of second hand-smoke. 
• Nicotine can decrease your milk supply and may cause vomiting, diarrhea, restlessness, and colic in your baby.
• The more tobacco you use, the more nicotine there is in your milk. 

Before using tobacco:

• Breastfeed/chestfeed or pump right before using tobacco. This allows your body time to process the nicotine before you are due to feed or pump again.
• Smoke way from your baby and wear something over your clothes and hair that you can remove when you go back to your baby.
• Do not let others use tobacco near you and your baby. 

After using tobacco:

• Change clothing and wash your hands and face.
• Wait at least 90 minutes to breastfeed/chestfeed or pump again.

During hospitalization at Seattle Children’s:

If you use any form of any of these substances and do not feel that you can stop, it may be best not to lactate at all. Talk to your healthcare provider and discuss resources to help you stop using. If you feel that you can stop using, we recommend you do not breastfeed/chestfeed or give your pumped breastmilk/chestmilk to your baby for 7 days after your last use. Babies can die from exposure to illegal substances through your milk. Exposure can cause babies to have seizures, extreme irritability, sedation/sleepiness, diarrhea, vomiting and dilated pupils. 

• Get help from a drug treatment program. Social Workers can provide resources to get you started.
• Your baby will be fed formula or donor milk (talk to your medical team) during these 7 days.

To start or maintain your milk supply when you are not feeding your milk to your baby pump 8 times per day to maintain your milk supply.

• Pump 8 times per day to start or maintain your milk supply. 
• Discard/dump this milk – do not save or store it.
• After 7 days, you can start to save/use milk and/or start breastfeeding/chestfeeding.

If you have a “slip up” and occasionally use, before using:

• Make sure your baby is being cared for by someone who is not using drugs.
• Make sure your baby is not sleeping on the same surface or sharing a bed with anyone who is taking illegal substances. 
• If your baby is breathing in second-hand smoke from drugs, it is as dangerous as if you are using drugs and breastfeeding/chestfeeding. Do not let people use illegal substances around your baby.
• If your baby is in the hospital, you must again start the 7 days of “pumping and dumping” to keep your baby safe.

The Washington State Department of Health has drug-specific handouts to support parents in making positive infant care decisions and reducing the harms of substance use.
waportal.org/partners/pregnant-parenting-children-familiesand-substance-use-workgroup/lactation-guidance-andpatient-education