“Infant formula is almost always more hazardous for the mother and baby than is breast milk with a tiny amount of medication.”

The vast majority of medications, whether over the counter (OTC) or prescription, are considered safe for breastfeeding. Still, many breastfeeding people wean unnecessarily when taking a medication. Why is this the case?

When you visit your doctor regarding a health concern, they will likely consult the PDR (Physician’s Drug Reference) when recommending a drug. The PDR references the pharmaceutical companies’ own research regarding safety. If the pharmaceutical company does not have any large, controlled studies that prove the safety of the drug when breastfeeding, the listing will indicate “unsafe for breastfeeding.” According to Dr. Thomas Hale, .”… the PDR is the poorest source for obtaining accurate breastfeeding information.”

I’ve been lucky enough to hear Dr. Thomas Hale speak on 3 different occasions. Mind you, some of those had the same content.  It took me that long to really understand all that he was saying. He’s a Ph.D. pharmacologist and one of the smartest men I’ve ever met. His book, “Medications and Mothers’ Milk” is the Bible of drugs and breastfeeding. When a parent calls me to ask about a medication, this is the book I reference.

Before evaluating a particular drug for safety, there are many, many factors to consider. It’s usually not a question of yes or no. Rather… it depends. It’s a complicated subject. But I hope to simplify things a little bit for you. Here are some of the important details when considering a medication.

The risk associated with “pumping and dumping” which may lead to formula feeding.
The age, size and health of the baby.
The length of time the medication is needed.
The dosage of the medication.
The time of day the medication will be used.
The volume of milk the baby is taking in. (Is baby eating solids? Is baby only partially breastfed?)
Is the medication really necessary?
Is the drug approved for use with babies?
Is there an alternative medication that may be less risky?
How is the drug administered? Orally or an injection?
How long does the baby stay active in your system?

Here’s an example. Let’s say you have severe insomnia because of an unforeseen stress in your life. You usually sleep well. Your Dr. prescribes 5 mg of ambien (zolpidem), a sleeping pill, and gives you 3 pills. They tell you that it’s not safe to take the medication if you are breastfeeding. It may make the baby lethargic. Your baby is a healthy, chubby 5-month-old and consistently sleeps for 6-7 hours in a row at night. He sleeps in your room, but not in your bed. The baby’s father is home and can help meet his nighttime needs. Looking at the factors above, you realize that you will take the medication at night when the baby is sleeping. Most of the medication will be in your bloodstream when your baby is not nursing. Your baby is big, so the relative dose of the medication is small, if he does nurse. Lastly, you will only take this medication for a few days at most.

Let’s look at another scenario. Your baby has just come home from the hospital after a premature birth. She weighs 5 1/2 pounds and has had some episodes of sleep apnea. She is sleepy and has a difficult time staying awake for feedings. You are stressed and having a hard time sleeping. You have a history of chronic insomnia. Your Dr. prescribes zolpidem and wants you to take it for 2 weeks and tells you it’s not safe to continue breastfeeding while on that medication. This situation is completely different from the first scenario. The premature baby could be seriously impacted by the zolpidem via your milk because she is so small, (making the relative dose bigger). She is nursing very frequently and already having trouble staying awake to get enough nutrition. You are also likely to take the medication more often and for a longer period of time than in the 1st scenario.

So you can see how the same medication, with the same warning label, can have a very different impact depending on the individuals involved. Before you wean unnecessarily or give your baby formula during the course of the medication, please consider the situation and the characteristics of the baby. The characteristics of a particular drug are also important and are beyond the scope of this post.

If you have any concerns about a medication, please don’t try to figure it out yourself. Ask your Dr. or lactation consultant to look it up for you in the most recent edition of Hale’s “Medications and Mothers’ Milk.” It is very likely that you will be able to continue breastfeeding!