What if I have a chronic medical condition?

If you need to take medication every day, you may still be able to nurse your baby if you’re willing to try dosage adjustments and alternative medications if necessary.

Allergies: Old standards (eg, Benadryl, Sudafed) are considered safe for use during breast-feeding. Nonsedating antihistamines (eg, Allegra, Claritin) are okay for short-term use. Over the long term, though, a steroid nasal spray (eg, Beconase, Flonase) or a cromolyn nasal spray (Nasalcrom) or inhaler (Intal) may be preferred.

Asthma: Inhaled steroids (eg, Flovent, Tilade) are a good bet. Oral steroids have been used for many years, and are considered safe during breast-feeding.

Heart disease: Standard medications, including diuretics, beta-blockers (eg, Inderal, Lopressor), calcium channel blockers (eg, Calan, Procardia), and ACE inhibitors (eg, Vasotec), are considered safe in breast-fed infants.

Diabetes: Most nursing mothers can use insulin or other drugs (eg, Glucotrol, Micronase, Orinase, Precose) without undue worry. However, you may want to avoid using Actos, Avandia, or Glucophage until more studies on their safety have been performed.

Epilepsy: Dilantin, Depakote, and Tegretol are considered preferable to other antiepileptic medications in terms of safety in breast-fed infants. However, nursing infants of Depakote and Tegretol users should undergo regular monitoring of liver function and blood cell counts.

Psychiatric conditions: Failure to take medication for certain disorders may hurt both you and your baby. The American Academy of Pediatrics describes the effects of nearly all antidepressants, anti-anxiety drugs, and antipsychotic drugs as “unknown but of possible concern.” In practice, some of these medications can be used safely if you and your baby are monitored carefully and dosages and drug selection are adjusted when necessary.

Depression: Most antidepressants are considered safe for use during breast-feeding, but the tricyclics (eg, Elavil, Norpramin, Pamelor) and selective serotonin reuptake inhibitors (eg, Prozac, Zoloft) are favored. Less information is available on the safety of Desyrel, Effexor, Serzone, and Wellbutrin in breast-fed infants.

Anxiety: Shorter-acting medications such as Ativan, Restoril, and Xanax are preferred over Valium, which stays in the mother’s system for a longer period of time.

Psychosis: Haldol and Thorazine are the best choices for nursing mothers, but only in low doses. Lithium use is not recommended; if it’s absolutely necessary, infants’ blood concentrations should be monitored.

Source article: What You Should Know About Medication Use While Breast-Feeding
Patient Handout prepared by Patricia L. Van Horn using materials from the American Academy of Pediatrics (www.aap.org) and the American Academy of Family Physicians (http://home.aafp.org).

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