MEDICINES IN BREASTFEEDING
Breast milk provides babies with unique nutrients that are ideal for their immune protection,
growth and development. If you are concerned about the safety of any medicines you aretaking while breastfeeding, seek the advice of your doctor or healthcare provider.
This factsheet contains general advice only; it is not intended to replace the individual care and advice of your healthcare provider. It
does not include information about all side effects and should be read together with the product information provided with medicines.

What are medicines?
Medicines are preparations used for the treatment orprevention of disease. Medicines include:••

Prescription medicine - prescribed by doctors,
dentists or other health professionals
Over-the-counter (OTC) medicine - purchased overthe-counter at pharmacies, supermarkets or healthfood stores.

Medicines taken by breastfeeding mothers may passinto breast milk, usually in small quantities and rarely
affects breastfed babies.
*For information on the use of herbal and traditional medicines
please refer to the Herbal Medicines in Pregnancy andBreastfeeding factsheet.

Is it safe to use prescription medicine while
I am breastfeeding?
Most medicines are safe to take while breastfeeding.
Talk to your doctor about the risks and benefits to you
and your baby of any medicines you are prescribed.
Also, ask your doctor about ways to reduce the amountof medicine passed into your breast milk. For example, it
may be possible to take a lower dose of your medicine,take it for a shorter period or be able to take a quicker
acting form to help reduce how much is passed into yourbreast milk.
When taking any medicine, watch for signs of possible
side effects in your baby, such as increased sleepiness,rash and severe diarrhoea.
It is important to understand why you are taking a
medicine and how to use it effectively and safely.
Please talk to your doctor or pharmacist before starting
any new medicines or stopping medicines whilebreastfeeding.

MEDICINES IN BREASTFEEDING – JUNE 2018

Is it safe to use over-the-counter (OTC)
medicine while I am breastfeeding?
It is usually safe to take OTC medicines whilebreastfeeding. However, the label on non-prescription orOTC medicines usually advises breastfeeding women to
speak to their doctor or pharmacist before using themedicine.
The following information contains general advice on
treating common conditions with OTC medicines while
you are breastfeeding.

What can I take for aches and pain?
Paracetamol may be used while breastfeeding1 at therecommended dose to treat mild pain, such as
headaches, toothaches, muscular pains or to reduce
fever.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen or diclofenac may be taken to help relieve painand inflammation.
Low doses of aspirin, less than 150mg daily, areconsidered safe to take. Avoid large doses of aspirin
while breastfeeding as it may be harmful to yourbreastfed baby.3,4What can I take for allergies and hayfever?
Allergies and hayfever symptoms include a runny andblocked nose, sneezing, itching of the nose, eyes, ears
or throat and watery, red irritated eyes. Avoid
aggravating factors where possible, such as pollen,house dust mites and animal dander (tiny flakes of skinshed by animals and pets, similar to human dandruff
only smaller), where possible.

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Antihistamines

Sore throat

Less sedating antihistamines such as loratadine can beused while breastfeeding for the relief of allergies andhayfever.5 Sedating antihistamines are notrecommended because the medicine may pass into yourbreast milk and make your baby drowsy.

Throat lozenges containing local anaesthetic,
antibacterial agents or benzydamine may be used whilebreastfeeding. Avoid excessive use as it may cause
unwanted side effects such as diarrhoea.

Eye drops
Topical eye drops for allergies and hayfever may be
used as the amount transferred into breastmilk is likely
to be low. Apply pressure against the inner corner of theeye (over the tear duct) for one to two minutes and blot
away any excess drops – this will help lessen how much
medicine gets into your system.

Nasal sprays
Corticosteroid nasal sprays containing beclomethasone
and budesonide are considered safe to use during
breastfeeding. Decongestant nasal sprays containing
oxymetazoline, xylometazoline or tramazoline may be
used if corticosteroid and antihistamine nasal sprayshave not relieved the symptoms.

What can I take for cold and flu?
The common cold is caused by a virus. It is best to treat
the individual symptoms of the common cold or flu.
Single ingredient products are usually preferred for shortterm use at the recommended doses. If you are feelingvery unwell because of a cold, the flu or sinus problems,
you should contact your doctor.

Cough
For a dry cough, a cough suppressant such as
pholcodine or dextromethorphan is considered safe
while breastfeeding. A dry, irritating cough is usuallyassociated with a postnasal drip.
For a chesty or productive cough, an expectorant suchas guaifenesin or a mucolytic such as bromhexine may
be used at the recommended dose.

Nasal symptoms
Steam inhalations and sodium chloride 0.9% nasal drops
or sprays may be used to relieve a blocked nose inbreastfeeding women. In general, a decongestant nasal
spray containing oxymetazoline, xylometazoline ortramazoline may be used for 3 to 5 days. There is anincreased risk of developing rebound congestion fromprolonged use of nasal decongestants.

Gargling salt water or drinking lemon and honeyproducts may also help to ease a sore throat.
Avoid throat gargles containing povidone-iodine because
it may affect the thyroid function of both you and yourbaby.7

What can I use for cold sores?
Prevention of cold sores is always better than treatment.
To prevent cold sores, it is recommended that you:• use lip-balm with SPF 15+• avoid stress• avoid too much sun and wind exposure• avoid injury to the lips or skin
• avoid foods or drinks that can trigger an outbreak.
The recommended treatment for cold sores is ice
applied to the affected area as well as using lip balms tokeep the area moist. Aciclovir cream can be used at therecommended dose during breastfeeding. Famciclovir
tablets are not recommended for use during
breastfeeding. If the cold sore is severe, or if further
treatment is needed, speak to your doctor for aprescription medicine.

What can I take for constipation?
It is always better to try adding more fibre to your diet(for example, fruit, vegetable, cereals, etc.) and drinking
plenty of water (aim for eight glasses a day) before
taking medicines. Remember that dietitians can help youwith dietary advice. If you do require a laxative, yourdoctor or pharmacist will advise you on the most suitableproduct.
Stool softeners such as docusate or osmotic laxatives
such as lactulose, glycerol or macrogol are safe to use
at the recommended doses while breastfeeding.
Stimulant laxatives such as senna or biscodyl may passinto the breast milk and cause diarrhoea in your baby.

Avoid oral decongestants such as pseudoephedrine or
phenylephrine as they may reduce breast milk supply.6
MEDICINES IN BREASTFEEDING – JUNE 2018

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What can I take for diarrhoea?
Most cases of diarrhoea are short-lived and do not
require treatment with medicines.
Oral rehydration solutions are recommended to replace
the loss of fluid and electrolytes.

Treatment of the affected person, all household/family
members and close contacts (even if they do not havesymptoms) should occur at the same time to avoid reinfestation and further transmission.

What can I use for mouth ulcers?

Loperamide may be used while breastfeeding to treat
the symptoms of diarrhoea. There is no need to stopbreastfeeding if you have diarrhoea. If the diarrhoea is
profuse, watery, bloody, accompanied by othersymptoms such as fever or severe abdominal pain, or
persists for longer than 48 hours you should see yourdoctor.

Most mouth ulcers generally heal by themselves. Some
over-the-counter creams or gels may be used to easethe pain or discomfort. Creams and protective pastes aresafe to use while breastfeeding. Salicylic acid orbenzydamine containing products may also be used.
Talk to your doctor or pharmacist for further advice
before using any of these products.

What can I take for heartburn?

What can I use for vaginal thrush?

Most cases of heartburn do not require treatment withmedicine. Dietary and lifestyle changes can relieve mild
symptoms. Try eating small, frequent meals and avoid
rich or spicy meals, chocolate, citrus foods and coffee.
Avoid lying down straight after a meal. If you need some
symptom relief, use an antacid or ranitidine to ease
discomfort. Talk to your pharmacist or doctor for advice if
symptoms persist.

Topical antifungal cream and pessaries containing
clotrimazole, miconazole and nystatin are safe to use
while breastfeeding. A single dose of oral fluconazole isconsidered safe when oral treatment is preferred. A
small amount of fluconazole is transferred into the breast
milk, but it is unlikely to produce any harmful effects inyour breastfed infant. Talk to your doctor or pharmacist
for further advice.

What can I use for head lice?

What can I use for haemorrhoids?

To treat head lice, use the “comb and conditioner”
method to remove head lice and eggs every second day
until no live lice have been found for 10 days.

The use of anorectal products such as ointments or
suppositories to treat haemorrhoids are safe whilebreastfeeding as it is unlikely to be passed into breast
milk. The best treatment is prevention. It is important to
eat additional fruit and fibre and drink plenty of fluid inorder to avoid constipation.

Topical preparations containing permethrin are thetreatment of choice while breastfeeding. Dimeticone orpyrethrin/piperonyl butoxide can also be used if needed.
Your doctor or pharmacist can advise you on the mostsuitable preparation.
Treatment should be repeated in 7 days to kill lice thathave hatched. Examine family members and close
contacts for head lice infestation. If showing signs andsymptoms of infestation, treat at the same time toprevent the spread of the infection. Bedding and clothingshould be removed and washed in hot water.

What can I use for worm infections?
Both pyrantel and mebendazole are safe to use to treat
worm infections while breastfeeding as they are poorly
absorbed from the gut and unlikely to be passed into
breast milk.
To prevent another worm infection:•What can I use for scabies?
If you suspect you may have scabies, speak to yourdoctor for treatment options while breastfeeding.
Permethrin is the treatment of choice for breastfeeding
women.
The nipple area should be cleaned of any topical
products before your baby attaches to the breast to feed.
Reapply the product to the washed area after feeding.

MEDICINES IN BREASTFEEDING – JUNE 2018•••••Wash hands and nails thoroughly with soap andwater, particularly after going to the toilet, after
changing nappies, before preparing food and before
eating food.
Discourage scratching of the bottom and nail biting.
Keep fingernails short.
Bathe or shower daily.
Wash all sheets, bed linen, pyjamas and sleepwear in
hot water to kill any pinworm eggs.
Clean the toilet seat regularly with disinfectant.

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For more information and advice

Ask your doctor or pharmacist

Medicines Information Service
Pharmacy Department
Level 1, The Royal Women’s Hospital
20 Flemington Road
Parkville VIC 3052

Use this section to jot down any questions you may haveabout this information for your doctor or pharmacist.

Hours: 9am to 4pm Monday to Friday
T: (03) 8345 3190
E: drug.information@thewomens.org.au
Related fact sheets on the Women’s website• Medicines in pregnancy• Herbal medicines in pregnancy and breastfeeding
W: www.thewomens.org.au

If this fact sheet does not answer your questions
about a particular medicine or you are still unclear
about what you should do, then seek further advice.
Your doctor, local pharmacist and the Royal
Women’s Hospital Medicines Information Service
can assist you in making decisions regarding thesafety of medicines while breastfeeding.
The Women’s Medicines Information Service also
provides healthcare professionals with tailoredadvice regarding the safety of medicines to suit thewomen under their care.
NOTE: Information about the references used in thewriting of this factsheet are available on request from theMedicines Information Service.

Disclaimer: This factsheet provides general information only. For specific advice about your baby or your healthcare needs, you should seek advice from your health professional.
The Royal Women’s Hospital does not accept any responsibility for loss or damage arising from your reliance on this factsheet instead of seeing a health professional. If you or yourbaby require urgent medical attention, please contact your nearest emergency department. © The Royal Women’s Hospital 2013–2018

MEDICINES IN BREASTFEEDING – JUNE 2018

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