Medication during breastfeeding

introduction

There is no general agreement on drugs that are safe for mother and child during breastfeeding. Similar to pregnancy, most drugs are not specifically approved for use during breastfeeding. The reason for this is that it would be unethical to conduct studies on breastfeeding women and thereby endanger the well-being and health of their children for the purpose of scientific knowledge. Animal experiments cannot be transferred to humans without reservation.

The use of most medications while breastfeeding is called "Off-label use"Take place, so without approval of the drugs for breastfeeding women by the manufacturer, who thus insures itself. However, this does not automatically mean that all unapproved drugs cause harm. On the contrary, many diseases during breastfeeding can and should be dangerous for both mother and child absolutely be treated with medication.

One prefers to pick up on this when breastfeeding old, well-known drugs back. It is assumed that because there have not yet been any cases of damage to the child, the drug is considered safe during breastfeeding. In the vast majority of cases, such a drug is available as an option and can be prescribed by the doctor.
Often the reference to package inserts that there is no information about the dangers in pregnant and breastfeeding women creates a great deal of uncertainty. The doctor can access databases on the Internet on which Safe medication during pregnancy and breastfeeding can be found. The patients can also inform themselves here, but should always consult with a doctor they trust. This can be the family doctor or the pediatrician or gynecologist.

In case of serious illnesses The mother, for whom there are no harmless alternatives in terms of medication, may sometimes have to stop breastfeeding for several days interrupt, depending on how long the drug has been in use in breast milk. This can be the case, for example, in the context of a severe infection, when the germ is only sensitive to certain antibiotics, which in turn can be harmful to the baby through breast milk.

Which are allowed?

First of all, it can be assumed that almost all drugs have a certain percentage in the Breast milk pass over. How large this proportion is and what damage the active ingredient can cause in the child, however, varies greatly. Doctors or pregnant and breastfeeding women can obtain information about specific medications themselves on some websites.

While breastfeeding will act like during pregnancy well-known medicines resorted to where previously no cases of side effects in the infant appeared. For this reason, these drugs are considered safe. However, controlled studies during pregnancy and breastfeeding only exist for very few drugs.

Paracetamol

Paracetamol is a pain and fever lowering drug that can be used for mild to moderate pain. It is one of the most widely prescribed drugs and is freely available from pharmacies without a prescription. In general, however, it should be noted that so-called "Over-the-counter“Medicines that can be bought in pharmacies without a prescription are in no way harmless, neither for the mother nor for the breast-fed child.
However, there is a wealth of experience with the use of paracetamol, so studies have shown that paracetamol does not have a negative effect on the infant during breastfeeding. However, the maximum daily dose should be respected, especially with regard to the breastfeeding mother, since paracetamol in overdose can cause life-threatening liver failure.
In the correct dosage, however, it is the method of choice for the treatment of moderate pain and fever (e.g. Headache, stomach ache, feverish infections) during breastfeeding and also during all three trimesters of pregnancy.

Read more on the topic: Paracetamol in breastfeeding

Ibuprofen

Ibuprofen heard (such as. also Diclofenac / Voltaren®) to the group of NSAIDs (nonsteroidal anti-inflammatory drugs). Like paracetamol, it works against fever (antipyretic), against pain (analgesic) and in contrast to paracetamol also against inflammation.
Common areas of application are headaches, back pain and rheumatism. In addition to paracetamol, ibuprofen is also the agent of choice for moderate pain, fever and inflammatory pain such as rheumatism during breastfeeding (of course, taking into account the maximum daily dose).

You can find more information here: Ibuprofen during breastfeeding

For gastrointestinal diseases

As a rule, breastfeeding is necessary if the mother has a gastrointestinal infection not interrupted become. This is especially true for Viral infectionswhich are self-limiting after a few days. It has even been shown that breastfed children suffer less frequent and less severe gastrointestinal infections because their immune system is better trained. The pathogens will not have that Breast milk transmitted to the child, but most gastrointestinal diseases are transmitted through stool and vomit.
Be against it antibodythat form in the mother's body during the course of the disease are passed on to the baby in breast milk.
A thorough hygiene after using the toilet and regular hand washing (also for the whole family) are necessary to protect the infant. In the case of such a viral infection is also no drug therapy expedient, home remedies (like cola and pretzel sticks to balance electrolytes, teas and hot water bottles) a similarly good effect can be achieved. The same applies to a simple upset stomach.

In case of more serious gastrointestinal infections With fever or after stays abroad caution is advised, as this may be a bacterial or parasitic infection. A doctor should be consulted here and breastfeeding may be due to the illness or antibiotics that become necessary interrupted must become.

Many breastfeeding mothers also suffer from Constipation (constipation), it is advisable to start with one high fiber diet to change and make sure you drink enough. The next step will be linseed or Indian psyllium husks Recommended as a natural swelling agent in the intestine, these are not absorbed and are therefore completely harmless. If the effect is not sufficient, then Lactulose the laxative (Laxity) of choice when breastfeeding.

cold

In the context of a common virus infection, therapy is limited to symptomatic treatment of the symptoms. Decongestant nasal spray can be used safely to improve nasal breathing. Since the active ingredient is effective locally, it can be assumed that only a very small percentage gets into breast milk. However, it is important not to use the decongestant nasal spray for longer than 7 to 10 days, as otherwise the nasal mucous membrane becomes accustomed to it, which without the spray permanently swells and hinders breathing through the nose (Privinism).
An even less complicated alternative is nasal irrigation with saline solution.

Find out all about the topic here: Breastfeeding with a cold.

Against pain (e.g. Headaches and body aches), both ibuprofen and paracetamol are suitable if the maximum daily dose is observed. If inhalations are insufficient to dissolve the mucus, acetylcysteine ​​(ACC cough remover), which is considered the expectorant of choice for breastfeeding women. Combination preparations for colds are not advisable during breastfeeding, as they contain several unmanageable active ingredients which, in combination, can be harmful to the child and, like many cough syrups, often contain alcohol (alcohol during breastfeeding).

Studies have shown that recovery is not accelerated by special over-the-counter cold products, so you can use tried and tested home remedies (Inhalation, teas, hot lemon) are on the safe side, especially during pregnancy and breastfeeding.

Read more about this under Home remedies for a cold while breastfeeding

a headache

They are particularly suitable for headaches during breastfeeding Ibuprofen and Paracetamol, although ibuprofen is often more effective for headaches. Both drugs are considered to be harmless, as there is already a great deal of experience with their use in pregnancy and breastfeeding no harm to the child could be shown by ingestion by the mother. In case of a migrainewhere a permanent medication for prophylaxis e.g. with beta-blockers is necessary, you should definitely consult your doctor.

hay fever

In the case of nasal sprays with locally effective antihistamines such as Azelastine or Levocabastine the experience is rather low. In principle, both active ingredients are considered harmless during breastfeeding, however, the transmission through breast milk has not been adequately investigated and the antihistamine may excite or sedate the child not excluded become. The same applies to systemically effective (given in tablet form or as an infusion) Antihistamines like Loratadine or Cetirizine.

Locally applied glucocorticoids such as Budesonide are considered harmless. Likewise can Cromoglicic acid can be used safely as mast cell stabilizers. Systemically effective glucocorticoids such as Prednisolone are harmless under short-term high-dose treatment or long-term low-dose therapy, as the portion transferred with breast milk corresponds to only a small portion of the infant's own cortisol production.

Sinus infection

Decongestant nasal sprays make it easier to breathe through the nose and thus reduce sinusitis (Sinusitis). Because the sprays are applied locally and only to one tiny proportion are absorbed and passed on in breast milk, they are well suited for therapy during breastfeeding. Inhalations (e.g. with table salt) have been shown to be effective. Expectorant like ACC (Acetylcysteine) can also be used safely during breastfeeding. Paracetamol or ibuprofen can be used as pain relievers.

Since the acute sinus infection (Sinusitis) mostly in the context of a viral infection (Rhinitis / runny nose) the upper respiratory tract occurs is the symptomatic therapy sufficient. Is there a bacterial infection before, so is the use of Antibiotics necessary. In this case, the doctor has to decide individually which agent is effective against the germ on the one hand and harmless to the baby on the other.

high blood pressure

The drug of choice as a blood pressure reducer during pregnancy and breastfeeding is Alpha methyldopa, a relatively old and proven antihypertensive (Antihypertensive drugs). Also certain Beta blockers how Metoprolol are considered Means of choice for high blood pressure during breastfeeding.

Older ACE inhibitors like Captopril, Enalapril or Benazepril can be taken during breastfeeding if the first choice of antihypertensive drugs (such as methyldopa, metoprolol) are ineffective or contraindicated.
Diuretics like Thiazide diuretics (HCT) seem to be relatively well tolerated in low doses during breastfeeding. Higher doses, which lead to increased water loss through the urine, can cause the Decrease milk production. For example, hydrochlorothiazide was previously to the Weaning used. Be among the calcium antagonists Nifedipine or Nitrendipine prefers.