A look at medication use while breastfeeding, the types of medications that may decrease your milk production, and the pharmaceutical galactagogues that can be prescribed by a doctor to help boost production.

A Deeper Look:

Medications and Breastfeeding Generally

Your baby will be exposed to some concentration of most medications you take.  For this reason, a mama should never self-prescribe medication, even natural plant-sourced remedies, and should always make sure to inform all of her treating healthcare professionals that she is breastfeeding.  Once you take a medication, it does not stay in your breast milk until that breast milk is removed—the level of medication in your breast milk rises and falls along with the levels in your blood.

To Breastfeed or Not to Breastfeed

Many medications are compatible with breastfeeding, but in some instances, your healthcare professional may tell you that you cannot continue breastfeeding while taking a particular medication.  If you do not want to stop breastfeeding, perhaps get a second opinion on whether you have to stop breastfeeding and/or whether you need the medication offered or whether there is an alternative that is safer for your baby.  If you are in the hospital and have concerns about the safety of a procedure or medication on breastfeeding, ask for a lactation counselor.

When making a decision on medication for a breastfeeding mama, a healthcare professional should consider your needs, your baby’s age, the potential effects of the drug on milk production, the potential adverse effects on a breastfeeding baby, the life of the drug, the length of the treatment, the history of the drug, how the drug is administered (how it is administered—mouth, inhaler, creams, injection makes a difference in how much will get into your bloodstream and to your baby), and whether pumping and the dosage can be coordinated in a way to minimize the amount of the medication in your milk.

If your doctor needs more information on a medication, the CDC and the American Academy of Pediatrics recommend a database known as LactMed, which is maintained by the U.S. National Library of Medicine at the National Institutes of Health, as a source of information on medication use while breastfeeding.  The website can be accessed here.  Also recommended by many of the sources I reviewed is the book Medications and Mothers’ Milk by Dr. Thomas Hale, which provides the half-life for many of the medications listed.

If it is determined that a medication is incompatible with breastfeeding, you can decide to continue pumping but dump the milk expressed while taking the medication.  Make sure you clearly understand when the drug will be out of your system following your final dose before you resume using your milk to feed your baby.  Examples of some drugs that are incompatible with breastfeeding include radioactive drugs and chemotherapy. 

Medications that Can Negatively Impact Milk Production

Some medications can negatively affect your milk production, but most times, once you have removed the medication, your milk supply will improve.  Common culprits include:

• hormonal birth controls including, at times, the minipill, subdermal implants, and IUDs but especially ones including estrogens
• local injection of a high dose corticosteroid
• medications to treat high prolactin levels
• Methylergonovine (used to prevent and control bleeding from the uterus after childbirth)
• Bromocriptine (blocks the release of prolactin from the pituitary gland)

According to Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, hormones such as estrogen, progesterone, and testosterone can inhibit milk production if their levels are too high or synthetic versions are introduced at the wrong time during lactation. Even some over-the-counter medications can negatively affect your milk production.  One example is pseudoephedrine, which is found in many cold and allergy medications, such as Sudafed.  Some antihistamines, like Benadryl, and high doses of vitamins—such as vitamin b6— may fall into this category as well.

If you notice a decrease in milk production that you know is attributable to your medication but are unable to stop your medication, an herb galactagogue or lactogenic food may help.  For more information, click here.

In addition to medications and over-the-counter drugs affecting milk production, some herbs can have a similar negative impact.  For more information, click here.

Medications that May Help Milk Production

Taking certain medications in combination with additional milk removals can increase milk production.  This sort of a medication is known as a pharmaceutical galactagogue.  While galactagogues can be helpful if your milk supply has suddenly decreased, medications are not likely to increase milk production unless you are also removing milk more often and thoroughly.  Additionally, because every body is different, what may work for one mama, may not work for another.

For more an overview of on how to increase milk production, click here.

If you’ve seen pharmaceutical galactagogues discussed, likely the names Domperidone and Metoclopramide were mentioned.  Domperidone is normally prescribed for stomach issues, but is also known to stimulate prolactin—the hormone that stimulates milk production.  Domperidone is not currently available in the United States but more than one of my sources suggested a doctor could prescribe it through a compounding pharmacy.   Commonly reported side effects include dry mouth, headaches, and abdominal cramps.  

Similar to Domperidone, Metoclopramide is also used to treat stomach issues—specifically gastroesophagael reflux—and it can also stimulate prolactin.  However, Metoclopramide is not recommended for mamas who have a history of depression, and it can lead to depressive symptoms in mamas who have no prior history.  Other side effects can include sleepiness and agitation.  Additionally, tardive dyskinesia—a movement disorder that causes repetitive muscle movements in the face, neck, arms, and legs—is a rare side effect of Metoclopramide that can become permanent.  Although some of these side effects may not appear if Metoclopramide is taken for only a short amount of time.

Treatment of an underlying medical condition may also have a positive affect on your milk production.  For instance, if you have hypothyroidism—low thyroid function—you may struggle with milk production and/or let-downs.  For some mamas, replacing the T4 hormone returned their thyroid levels to the normal range but milk production issues were not resolved until a different medication—one including T3 and T4 was tried.  Bottom line? Pay attention to how your body feels and if you think something isn’t right, speak up!  If you think something you are taking may be negatively affecting your milk supply—talk to your doctor about it.

For more information on medical conditions, medications, and supplements and their affect on milk production, consider reading Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, Second Edition, Diana West, IBCLC, and Lise Marasco, M.A., IBCLC (2019).

The EP&Me Take:

About eleven months into EPing I got sick.  I put up with my symptoms for 3 weeks because my Little was in daycare, and if you have a kid in daycare, you know that your family is ALWAYS sick and most of the time you just need to move forward, push through, rest when possible, but basically just deal with it.  When I finally went to the doctor, my symptoms had not improved, and I was diagnosed with a sinus infection and told I needed to be put on an antibiotic based on the length of time I had symptoms.  I was also told that taking the antibiotic would mean that I would need to stop breastfeeding.

OOF.  Being told I need to stop breastfeeding made me upset.  I was only a few measly weeks short of EPing for a year and also, I wanted to wean on my terms.  So I tentatively asked if there was something else I could take.  I was told there wasn’t.  So I left the office, filled the prescription, and went home.  When I got home I thought, are there really no antibiotics a breastfeeding mama can take?  How can it be that my Little has been prescribed antibiotics but there isn’t one that I can safely take while breastfeeding?

I went back the next day, just to make sure there really were no other alternatives, but without an appointment, the doctor did not have time to see me.  I wasn’t ready to wean yet, so I just didn’t take the antibiotic.  I now think this was a possibly reckless decision—approximately 3 weeks later I weaned but I felt miserable for a month and a half and did not feel better until after I finally took those antibiotics.

Please learn from me.  What I should have done was get a second opinion.  I should have more firmly expressed how important breastfeeding was to me and my Little and sat there until we came up with a better solution.  I know now that there are antibiotics that are okay to take while breastfeeding, the doctor I saw just wasn’t knowledgable enough to help me navigate this situation, and I did not advocate well enough for myself.

I hope you have a doctor that understands your goals and works to incorporate those goals into your treatment plan.  Perhaps you really do need to stop breastfeeding—or at the very least pump and dump until the medication is out of your body—but maybe you don’t.  Maybe there is an alternative out there.  Wishing you good health mama.