Remedies prohibited and permitted in breastfeeding

Most drugs pass into breast milk, however, many of them pass in small amounts and, even when present in milk, may not be absorbed in the baby's gastrointestinal tract. However, whenever it is necessary to take a medication while breastfeeding, the mother must first speak to the doctor, to understand whether this medication is dangerous and whether to avoid it or whether it is necessary to stop breastfeeding.

In general, breastfeeding mothers should avoid the use of medications, however, if necessary, they should choose the safest and those that have already been studied and that are little excreted in breast milk, in order to avoid risks for baby's health. Medicines of prolonged use by the mother, generally, carry a greater risk for the infant, due to the levels they can reach in breast milk.

Medications that the lactating woman can not take

The following remedies must not, at any time, be used during lactation. However, if it is necessary to carry out treatment with any of them, breastfeeding must be stopped:

Zonisamide	Fenindione	Lisuride	Isotretinoin	Sildenafil
Doxepin	Androgens	Tamoxifen	Amfepramone	Amiodarone
Bromocriptine	Ethinylestradiol	Clomiphene	Verteporfin	Leuprolide
Selegiline	Combined oral contraceptives	Diethylstilbestrol	Disulfiram	Etretinate
Bromides	Mifepristone	Estradiol	Borage	Formalin
Antipyrine	Misoprostol	Alfalutropina	Blue Cohosh
Gold salts	Bromocriptine	Antineoplastics	Comfrey
Linezolid	Cabergoline	Fluoruracil	Kava-kava
Ganciclovir	Cyproterone	Acitretin	Kombucha

In addition to these drugs, most radiological contrast media are also contraindicated or should be used with caution in lactation.

What to do before taking a medicine to breastfeed?

Before deciding to use a medicine during lactation, a woman should:

Evaluate together with the doctor if it is necessary to take the medication, measuring the benefits and risks; Prefer drugs studied that are safe in children or that are little excreted in breast milk; Prefer medicines of local application, when possible; use of the medication, in order to avoid blood and milk concentration spikes, which coincide with the breastfeeding time; Opt, when possible, for medicines containing only one active substance, avoiding those that have many components, such as flu preferring to treat the most obvious symptoms, with paracetamol, to relieve pain or fever, or cetirizine to treat sneezing and nasal congestion, for example. If the mother uses a medication, she should observe the baby in order to detect possible side effects, such as changes in eating patterns, sleep habits, agitation or gastrointestinal disorders, for example; prolonged action, as they are more difficult to eliminate by the body; withdraw the milk in advance and store in the freezer to feed the baby in case of temporary interruption of breastfeeding. Learn how to store breast milk correctly.

Which remedies can be used while breastfeeding

The drugs listed below are considered potentially safe to use during lactation, however, none of them should be used without medical advice.

All other drugs that are not mentioned in the following list, should only be used if the benefits outweigh the risks. Even in these cases, they should be used with caution and under medical guidance. In many cases, suspension of lactation may be justified.

Drugs considered potentially safe in lactation

The following are considered safe in lactation:

Vaccines: all vaccines except the vaccine against anthrax, cholera, yellow fever, rabies and smallpox; Anticonvulsants: valproic acid, carbamazepine, phenytoin, phosphenytoin, gabapentin and magnesium sulfate; Antidepressants: amitriptyline, amoxapine, citalopram, clomipramine, desipramine, escitalopram, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, sertraline and trazodone; Antipsychotics: haloperidol, olanzapine, quetiapine, sulpiride and trifluoperazine; Anti-migraine: eletriptan and propranolol; Hypnotics and anxiolytics: bromazepam, cloxazolam, lormetazepam, midazolam, nitrazepam, quazepam, zaleplone and zopiclone; Analgesics and anti-inflammatories: flufenamic or mefenamic acid, apazone, azapropazone, celecoxib, ketoprofen, ketorolac, diclofenac, dipyrone, fenoprofen, flurbiprofen, ibuprofen, paracetamol and piroxicam; Opioids: alfentanil, buprenorphine, butorphanol, dextropropoxyphene, fentanyl, meperidine, nalbuphine, naltrexone, pentosan and propoxyphene; Remedies for the treatment of gout: allopurinol; Anesthetics: bupivacaine, lidocaine, ropivacaine, xylocaine, ether, halothane, ketamine and propofol; Muscle relaxants: baclofen, pyridostigmine and suxamethonium; Antihistamines: cetirizine, desloratadine, diphenhydramine, dimenhydrinate, fexofenadine, hydroxyzine, levocabastine, loratadine, olopatadine, promethazine, terfenadine and triprolidine; Antibiotics: all penicillins and penicillin derivatives (including amoxicillin) can be used, with the exception of cefamandol, cefditoren, cefmetazole, cefoperazone, cefotetan and meropenem. In addition, amikacin, gentamicin, kanamycin, sulfisoxazole, moxifloxacin, ofloxacin, azithromycin, clarithromycin, erythromycin, roxithromycin, clavulanic acid, clindamycin, chlortetracycline, spiramycin, furazolidone, lincomycin, oxychinicine, methinidine sulbactam, teicoplanin, tetracyclines, trimethoprim and vancomycin; Antifungals: fluconazole, griseofulvin and nystatin; Antivirals: acyclovir, idoxuridine, interferon, lamivudine, oseltamivir and valacyclovir; Anti-amebiasis, anti-giardiasis and anti-leishmaniasis: metronidazole, tinidazole, meglumine antimoniate and pentamidine; Anti-malaria: artemeter, clindamycin, chloroquine, mefloquine, proguanil, quinine, tetracyclines; Anthelmintics: albendazole, levamisole, niclosamide, pyrvinium or pyrantel pamoate, piperazine, oxamniquine and praziquantel; Tuberculostatics: ethambutol, kanamycin, ofloxacin and rifampicin; Anti-leprosy: minocycline and rifampicin; Antiseptics and disinfectants: chlorhexidine, ethanol, hydrogen peroxide, glutaral and sodium hypochlorite; Diuretics: acetazolamide, chlorothiazide, spironolactone, hydrochlorothiazide and mannitol; Remedies for cardiovascular diseases: adrenaline, dobutamine, dopamine, disopyramide, mexiletine, quinidine, propafenone, verapamil, colesevelam, cholestyramine, labetalol, mepindolol, propranolol, timolol, methyldopa, nicardipine, nifedipine, nimodipiline, miniphenyl, vermin, captopril, enalapril, quinapril and digoxin; Remedies for blood diseases: folinic acid, folic acid, iron amino acid chelate, ferromathosis, ferrous fumarate, ferrous gluconate, hydroxycobalamin, iron glycinate chelate, ferrous oxide sucrate, ferrous sulfate, dalteparin, dicumarol, phytomenadione, heparin, lepine, heparin, lepine, pentoxifylline, warfarin and plasma substitutes; Antiasthmatics: triamcinolone acetonide, adrenaline, albuterol, aminophylline, ipratropium bromide, budesonide, sodium cromoglycate, beclomethasone dipropionate, fenoterol, flunisolide, isoetarin, isoproterenol, levalbuterol, nedocromol, saline, flutterol, saline, propane; Antitussives, mucolytics and expectorants: acebrofilina, ambroxol, dextromethorphan, dornase and guaifenesina; Nasal decongestants: phenylpropanolamine; Antacids / acid production inhibitors: sodium bicarbonate, calcium carbonate, cimetidine, esomeprazole, famotidine, aluminum hydroxide, magnesium hydroxide, nizatidine, omeprazole, pantoprazole, ranitidine, sucralfate and magnesium trisilicate; Antiemetics / gastrokinetics: alizapride, bromopride, cisapride, dimenhydrinate, domperidone, metoclopramide, ondansetron and promethazine; Laxatives: agar, carboxymethylcellulose, starch gum, ispagula, methylcellulose, hydrophilic psyllium muciloid, bisacodyl, sodium docusate, mineral oil, lactulose, lactitol and magnesium sulfate; Antidiarrheals: Kaolin-pectin, loperamide and racecadotril; Corticosteroids: all except dexamethasone, flunisolide, fluticasone and triamcinolone; Antidiabetics and insulins: glyburide, glyburide, metformin, miglitol and insulins; Thyroid remedies: levothyroxine, lyothyronine, propylthiouracil and thyrotropin; Contraceptives: contraceptives should only be used with progestogens; Remedies for bone disease: pamidronate; Remedies to apply to the skin and mucous membranes: benzyl benzoate, deltamethrin, sulfur, permethrin, thiabendazole, ketoconazole, clotrimazole, fluconazole, itraconazole, miconazole, nystatin, sodium thiosulfate, metronidazole, mupirocin, potassium, potassium, bacromycin, potassium, potassium, bacromin, potassium, potassium, potassium, potassium, potassium, potassium, potassium, potassium, potassium, potassium., tetracyclines, calamine, pimecrolimos, aluminum diacetate, trichloroacetic acid, benzoyl peroxide, coaltar and dithranol; Vitamins and minerals: folic acid, fluoride, sodium fluoride, calcium gluconate, nicotinamide, ferrous salts, tretinoin, vitamin B1, B2, B5, B6, B7, B12, C, D, E, K and zinc; Medicines for ophthalmic use: adrenaline, betaxolol, dipivephrine, phenylephrine, levocabastine and olopatadine; Phytotherapics: St. John's wort. There are no safety studies for other herbal medicines.