Frank J. Nice, RPh, DPA, CPHP, Maryland, USA
The use of over-the-counter (OTC) medications by breastfeeding mothers is even more common than the use of prescription drugs. The sale and use of OTC drugs is a multi-billion dollar industry and there is an overwhelming variety of OTC products available to consumers—for common and not so common maladies. Consumers, including nursing mothers, can be confronted with a bewildering array of choices and most breastfeeding mothers have taken an OTC medication at some point.
There is always the possibility that a breastfed infant could receive OTC drugs through human milk just as with prescription drugs. To take an OTC medication, a mother does not need a doctor’s prescription. The decision to take an OTC medication is almost always made by the mother herself. Of course, family and friends may also influence her decision. She may or may not talk with her pharmacist for advice on taking the OTC medication or its safety during breastfeeding.
Classes of OTC medications that are available to nursing mothers include: analgesics (pain killers); antacids and digestive aids (for indigestion); appetite suppressants; asthma preparations; artificial sweeteners; cough, cold, and allergy preparations, including lozenges, inhalers, drops, rubs, sprays, and nasal preparations; diarrheal preparations; dietary supplements; ear and eye medications; heart attack and stroke risk reduction agents; hemorrhoidal preparations; insulin; laxatives and stool softeners; lice treatments; nausea and vomiting and motion sickness preparations; oral hygiene products; pinworm treatments; skin preparations for inflammation, itching, wound and burn care, fungal infections, calluses, corns, and warts, dandruff, pain, lubrication and cleansing, and sunscreens; sleep preparations; stimulants; smoking cessation aids; and vaginal agents.
In many cases, OTC medications consist of multiple ingredients for multiple symptoms. Many OTC medicines have both regular-strength and extra-strength forms of the same product. The medication may be short-acting or long-acting. In addition, mothers may find it difficult to follow complex package directions. They may take an inappropriate OTC medication or may have been given incorrect advice by family or friends. Thus, taking an OTC medication may not be as simple as it initially appears. It will probably be even more complex for consumers who are breastfeeding.
Although La Leche League Leaders can not tell a nursing parent whether or not it is safe to take an OTC medication, they can provide information to help the mother decide for herself and encourage the mother to discuss questions and concerns with a pharmacist or her baby’s health care provider. Here are some general guidelines:
- Avoid taking OTC medications for which little breastfeeding information is available. A pharmacist should be able to assist with additional information.
- Avoid taking OTC medications for which safer products are available Once again, a pharmacist can help determine this.
- Avoid taking combination OTCs, which are those with multiple ingredients. It is better for the mother to take an OTC that has the one or two specific ingredients that will treat her specific condition; there is no need for mothers or nurslings to be exposed to unnecessary ingredients.
- Avoid taking extra strength forms of OTC medications. There is no need for the nursling to be exposed to extra amounts of a drug when it is not needed.
- Avoid taking long-acting OTC medications. There is no need for the nursling to be exposed to a drug for a longer period of time, especially if an adverse reaction is possible in the nursling.
- The mother needs to know about possible side effects that might occur in her nursling, as well as herself—a pharmacist can help with this.
- If possible, as with prescription drugs, a nondrug approach is preferable for treating any symptoms.
With all the possible OTCs available, it may still be difficult to make a decision. There are literally thousands upon thousands of OTC products available for use by breastfeeding mothers.
To assist with decision making, I chose approximately 1,300 OTC medicines, herbals, and supplements to best represent those that the breastfeeding mother might need to use. These are reviewed in my book, Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition (see www.nicebreastfeeding.com). The information provided will help a breastfeeding mother select an OTC product that will treat her symptoms and allow her to continue breastfeeding safely.
Tables in the book list qualified “yes” and “no” answers regarding specific OTC preparations. The following codes apply:
- Y – Usually safe to take when breastfeeding (note any additional cautions)
- N – Avoid if at all possible when breastfeeding (note any additional comments)
Dr. Thomas Hale’s Lactation Risk Categories are also provided from Medications and Mothers’ Milk.
In most cases, ingredients in ear and eye, oral hygiene, topical (skin), and vaginal OTC preparations should not be present in breast milk in harmful quantities. If skin preparations are required for sore or cracked nipples, breast care products specifically for this condition should be used. Vitamins and minerals in daily recommended doses are usually safe for the nursing mother to take. Pediatric (children’s) OTC preparations are not in the tables, as most mothers would not be taking pediatric medications to treat themselves.
The OTC medications presented represent only the more commonly used products and product categories designated as OTC in the United States. Most OTC medications in the United States are also OTC in many other countries. Yet, there are some that remain prescription drugs in some countries. Also, dosage strengths and forms may vary from country to country. Thus, the tables are not meant to be all inclusive or comprehensive for all countries internationally.
The National Institute of Health in the United States hosts a drugs and lactation database called LactMed (https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm), which is also available as an app. Information about many OTC medications is included in this database.
Other countries also have their own medications databases; check with your local LLL Professional Liaison Department and see https://www.llli.org/
Medications and Mothers’ Milk Online 2018 [paywall] http://www.medsmilk.com is the online version of Medications and Mothers’ Milk by Thomas W. Hale, Ph.D.
Breastfeeding and Medication 2nd edition, 2018 by UK pharmacist Wendy Jones.
Dr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for 40 years. He holds a bachelor’s degree in pharmacy, a master’s in pharmacy administration, and master’s and doctorate degrees in public administration. During his distinguished career, Dr. Nice worked for the US Public Health Service, the National Institutes of Health and the Food and Drug Administration. He recently retired after 43 years of government service and currently is self-employed as a consultant and president of Nice Breastfeeding LLC.
Dr. Nice has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition and The Galactogogue Recipe Book. Dr. Nice has also authored many peer reviewed articles on the use of prescription medications, over the counter (OTC) products, and herbals during breastfeeding. He has organized and participated in over 50 medical missions to the country of Haiti.