28/06/2026
Ubat dan Penyusuan
Breastfeeding and Medicines - Take it or Leave it?🍼
This article is authored by Ms. Hor Cheah Yen, pharmacist, Ministry of Health Malaysia.
Breastfeeding has long been widely recognized as the optimal source of nutrition for infants, as it provides numerous health benefits for the infant. Since 1981, the World Health Organization has recommended exclusive breastfeeding for the first six months of an infant’s life, followed by continued breastfeeding alongside complementary foods for up to two years or beyond.
Nevertheless, many mothers express concerns about the safety of medicines used during breastfeeding. Breastfeeding mothers who require pharmacological treatment should therefore exercise caution when taking medicines to ensure that these do not pose harm to their infants while effectively managing their own health conditions. Despite this, many continue to encounter uncertainty regarding the safe use of medicines during lactation.
𝐃𝐨𝐞𝐬 𝐚𝐥𝐥 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐩𝐚𝐬𝐬 𝐢𝐧𝐭𝐨 𝐛𝐫𝐞𝐚𝐬𝐭 𝐦𝐢𝐥𝐤?
Although in theory, most medicines are transferred into breast milk to some extent, the majority of commonly used medicines by breastfeeding women can be taken safely. This is because the amount of medicine present in breast milk is usually small and unlikely to cause harm to the infant. In addition, breastfeeding women generally try to avoid taking medicines whenever possible and use them only when necessary.
Nevertheless, exceptions apply to certain medicines that may be present in high concentrations in breast milk or may exert harmful effects even at low concentrations. Therefore, each medicine must be evaluated on an individual basis.
The amount of a medicine that passes into breast milk depends on its pharmacokinetic properties. These factors include the molecular size of the medicine, the proportion of the drug that remains unbound in the bloodstream, and the duration for which the drug stays in the circulation.
When an infant is exposed to a medicine through breast milk, several factors determine whether side effects may occur. These include:
-timing of the dose, whereby feeding the infant before the mother takes the medicine results in the lowest possible drug exposure
-volume of breast milk consumed, since a lower intake is associated with a reduced risk of side effects
-age of the infant, as the newborns younger whose main organ functions are underdeveloped could affect how much of the medicine is absorbed, distributed or excreted
𝐄𝐱𝐚𝐦𝐩𝐥𝐞𝐬 𝐨𝐟 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐭𝐡𝐚𝐭 𝐚𝐫𝐞 𝐬𝐚𝐟𝐞 𝐭𝐨 𝐮𝐬𝐞 𝐝𝐮𝐫𝐢𝐧𝐠 𝐛𝐫𝐞𝐚𝐬𝐭𝐟𝐞𝐞𝐝𝐢𝐧𝐠
There are times when breastfeeding women may need to take medicines to treat short-term illnesses or long-term chronic conditions. Examples of medicines that are generally considered safe for use during breastfeeding include:
-pain relievers such as paracetamol, mefenamic acid, and ibuprofen. These medicines are generally recommended for short-term use and only when necessary.
-antimicrobial medicines used to treat infections when taken at standard therapeutic doses, such as amoxicillin, ampicillin, cloxacillin, cefuroxime, cephalexin, and erythromycin.
-antihistamines used to treat rhinitis or allergic reactions, such as chlorpheniramine, loratadine, and fexofenadine. However, some antihistamines, particularly first-generation agents, may cause drowsiness and should therefore be used with greater caution.
-contraceptive medicines that contain only progestin as the active ingredient.
medicines used to treat postpartum depression or anxiety, such as paroxetine, sertraline, and fluvoxamine.
-medicines used for the treatment of epilepsy, such as lamotrigine and carbamazepine.
-fibre-based laxatives are preferred during breastfeeding. Other types of laxatives may cause diarrhoea in the infant if taken in high doses by the mother.
vitamin and mineral supplements, such as iron and vitamin B.
𝐄𝐱𝐚𝐦𝐩𝐥𝐞𝐬 𝐨𝐟 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐭𝐡𝐚𝐭 𝐬𝐡𝐨𝐮𝐥𝐝 𝐛𝐞 𝐮𝐬𝐞𝐝 𝐰𝐢𝐭𝐡 𝐜𝐚𝐮𝐭𝐢𝐨𝐧 𝐨𝐫 𝐚𝐯𝐨𝐢𝐝𝐞𝐝 𝐝𝐮𝐫𝐢𝐧𝐠 𝐛𝐫𝐞𝐚𝐬𝐭𝐟𝐞𝐞𝐝𝐢𝐧𝐠
While most over-the-counter and commonly prescribed medicines are safe to use during breastfeeding, lactating mothers should still exercise caution when taking certain medicines. For example, decongestant medicines, containing ingredients such as pseudoephedrine or phenylephrine which are commonly used to relieve nasal congestion associated with colds, flu, or allergic rhinitis. These medicines may reduce breast milk supply. As a safer option, breastfeeding mothers may consider using saline nasal drops, nasal sprays, or a humidifier to help relieve nasal congestion.
Furthermore, there are some other medicines that are known to reduce or suppress breast milk production. These include ergometrine, diuretics such as hydrochlorothiazide, and oestrogen-containing oral contraceptive pills. Mothers are advised to consult their doctor or pharmacist for further information and appropriate alternatives.
For mothers with diabetes, antidiabetic medicines from the sulfonylurea group, such as gliclazide, should be avoided or used with caution during breastfeeding due to the risk of hypoglycemia in the infant. Certain antibiotics, such as chloramphenicol, tetracycline, metronidazole, and quinolone antibiotics, should be avoided during breastfeeding or used only under strict medical supervision. These medicines can pass into breast milk and may cause side effects in the infant, such as gastrointestinal disturbances or diarrhoea.
Cancer treatments such as chemotherapy medicines, including metabolites, as well as radioactive medicines, should be avoided during breastfeeding because these substances can pass into breast milk and pose significant risks to the infant. Medicines from the benzodiazepine group, which are commonly used to treat anxiety and insomnia, as well as opioid medicines prescribed for chronic pain may cause sedation and respiratory depression in the infant.
𝐀𝐝𝐯𝐢𝐜𝐞 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐩𝐮𝐛𝐥𝐢𝐜
Most medicines can still be safely used during breastfeeding, provided that those chosen are compatible with breastfeeding or pose a low risk of passing into breast milk in significant amounts. Mothers are advised to always inform their doctor or pharmacist that they are breastfeeding so that appropriate medicines can be selected. They should also discuss with a healthcare professional before starting or stopping any medicines. Use of health supplements and traditional preparation should also be informed to the doctors or pharmacists.
When medicines are necessary, mothers may consider feeding the infant just before taking the medicine to minimise the amount of drug transferred into breast milk. For short-term use of medicines that may pose a risk to the infant, mothers may consider expressing breast milk to maintain milk supply and discarding the milk for the duration of treatment. Breastfeeding should only be resumed after allowing sufficient time for the medicine to be fully eliminated from the body.
For mothers who require long-term treatment with medicines that pass into breast milk and may harm the infant, replacing breastfeeding with infant formula may be considered. This decision should be discussed with a doctor or pharmacist, including guidance on weaning and selecting an appropriate formula for the infant.
Nevertheless, careful monitoring of the infant is important when mothers are taking any medicines. Mothers are advised to observe their babies for any possible side effects, such as excessive sleepiness, unusual fussiness or irritability, changes in sleeping or feeding patterns, diarrhoea, skin rashes, breathing difficulties, or the infant appearing limp or floppy after feeding. If any of these signs are observed, mothers should seek medical attention promptly.
As a conclusion, breastfeeding remains the best option for infant nutrition, and most medicines can be used safely during breastfeeding when appropriately selected. The use of medicines during lactation requires a careful balance between effective treatment for the mother and safety for the infant, with each medicine assessed on an individual basis.
