Breastfeeding and Medication Safety in Brampton: A Guide for Nursing Parents

Sooner or later, almost every breastfeeding parent needs a medicine. It might be a pain reliever after birth, an antibiotic for an infection, a treatment for a cold, or a long-term prescription for a condition that existed before pregnancy. And with that need comes a familiar worry: will this get into my milk, and will it affect my baby?

That worry sometimes leads parents to avoid treatment they genuinely need, or to stop breastfeeding earlier than they wanted to because they were told, without much explanation, that a medicine was “not compatible”. In reality, many medicines can be used while breastfeeding, and when a particular one is a concern there is often a suitable alternative. The key is to ask, and to ask someone who can look at the specific medicine and your baby’s circumstances.

At Pharmasave Remembrance in Brampton, our pharmacists answer breastfeeding medication questions regularly. This article explains how those questions are approached and how you can prepare.

How medicines can pass into breast milk

Most medicines pass into breast milk to some degree, but the amount varies enormously. Factors that influence how much reaches the baby include the size of the drug molecule, how much binds to proteins in the blood, how quickly it is cleared from the parent’s body, and how well it is absorbed from the baby’s gut.

For many common medicines, the amount that reaches the baby is very small and unlikely to cause problems. For others, more caution is needed, either because more passes into milk or because even small amounts may affect an infant. A pharmacist considers these properties alongside published information about the medicine’s use during breastfeeding.

The age and health of your baby matter too. A newborn, a premature baby, or a baby with a health condition may clear medicines more slowly than an older, healthy infant. That is why the same medicine can be a straightforward choice for one family and a more careful decision for another.

Information to share when you ask about a medicine

To give you a useful answer, the pharmacist needs some details. Be ready to share:

• The name and strength of the medicine, or bring the prescription or package
• Why it was prescribed or why you want to use it
• How long you expect to take it
• Your baby’s age, and whether they were born early
• Whether your baby has any health conditions or takes any medicines
• How often your baby feeds, and whether they also receive formula or solid food
• Any other medicines, vitamins or herbal products you use

If you are seeing a doctor or dentist who prescribes something new, tell them you are breastfeeding before they write the prescription. Then mention it again at the pharmacy. It is a simple step that makes sure two sets of eyes consider the question.

Everyday medicines that come up often

Certain categories of medicine prompt breastfeeding questions again and again: pain relievers after delivery or for headaches, cold and allergy products, antacids, laxatives, antibiotics, creams for skin conditions and treatments for yeast infections. Some of these are generally considered suitable while nursing, some need care, and the right choice often depends on the specific product.

Combination cold and flu products deserve a particular mention. They often contain several ingredients, and some decongestants have been associated with reduced milk supply in some people. Rather than choosing based on the symptom listed on the box, ask the pharmacist which individual ingredient addresses the symptom that bothers you most.

For conditions that Ontario pharmacists can assess, such as vaginal yeast infections or urinary tract infections, the pharmacist will factor breastfeeding into their assessment and treatment decision.

Long-term prescriptions and planning ahead

If you take medicine for a long-term condition such as thyroid disease, epilepsy, depression, anxiety, asthma or high blood pressure, ideally the breastfeeding plan is discussed during pregnancy. Your prescriber may keep you on the same medicine, adjust it, or switch to one with more information supporting its use during nursing.

Do not stop a long-term medicine suddenly after delivery because you are worried about breastfeeding. The weeks after birth already involve sleep loss and big changes. A relapse of an underlying condition, especially a mood disorder, can make that period much harder. Ask first, then decide together with your prescriber.

A medication review can be a useful way to go through everything at once if you have several prescriptions. Ask the pharmacy whether you are eligible for a funded review.

Watching your baby after starting a new medicine

When you start a medicine while breastfeeding, the pharmacist may suggest what to watch for in your baby. Depending on the medicine, this could include unusual sleepiness, poor feeding, irritability, rash, or changes in bowel movements. Most babies show no change at all, but knowing what to look for gives you confidence.

If you notice something unusual, contact your pharmacist, your baby’s doctor or Health811. Bring the name of the medicine and when you started it. Do not wait for a scheduled appointment if your baby seems unwell, is not feeding, or is difficult to wake. Those situations need prompt medical attention.

Timing doses and other practical strategies

For some medicines, the pharmacist may suggest taking a dose right after a feed, or before your baby’s longest sleep, to reduce the amount in your milk at the next feeding. This approach is not necessary for every medicine, and it can be hard to apply with a newborn who feeds frequently and unpredictably. Ask whether timing matters for your particular medicine before rearranging your day around it.

Topical products such as creams, eye drops and nasal sprays generally result in lower levels in the blood than tablets, although this is not universal. If you apply anything to the breast or nipple area, ask whether it needs to be wiped off before feeding.

Supplements, galactagogues and herbal products

Parents who worry about milk supply sometimes turn to herbal products, teas or supplements marketed to increase milk production. Evidence for many of these is limited, and some can cause side effects or interact with other medicines. Before trying one, it helps to look at the underlying cause of supply concerns, which is often related to feeding frequency or latch rather than a need for a supplement.

If supply is a worry, talk with a lactation consultant, public health nurse or your healthcare provider. Peel Public Health offers breastfeeding support for families in the region; information is available through Peel Region’s website. La Leche League Canada is another source of parent-to-parent support. Then bring any product you are considering to the pharmacist for a safety check.

Vitamin D is a separate topic. Canadian guidance recommends a vitamin D supplement for breastfed babies; ask your baby’s healthcare provider or pharmacist about the right product and how to give it.

Contraception, mood and other postpartum prescriptions

Several medicine decisions tend to come up in the months after birth, and breastfeeding affects each of them. Contraception is a common example. Some hormonal methods are generally preferred while nursing, while others containing estrogen are usually discussed with more caution in the early postpartum weeks because of possible effects on milk supply and other health considerations. Your prescriber will weigh these factors, and the pharmacist can explain how to use whatever method you choose.

Mood is another. Postpartum depression and anxiety are common and treatable, and several treatment options are considered compatible with breastfeeding. Worry about nursing should never be the reason someone goes without care for their mental health. If you are prescribed a medicine for mood, ask the pharmacist what to expect in the first weeks and what, if anything, to watch for in your baby.

Finally, consider medicines for other family members. When a household is busy, it is easy for an adult’s prescription to be stored near the baby’s vitamin drops or for doses to get mixed up. Keep your own medicines separate, store them out of reach, and label anything you decant into a pill organiser.

Quick answers to common questions

Should I pump and discard milk after every medicine? Usually not. For most medicines this is unnecessary. If there is a reason to do so, the pharmacist or prescriber will tell you and explain for how long.

Can I have a flu shot while breastfeeding? Inactivated vaccines such as the flu shot are generally considered compatible with breastfeeding. Ask about flu shot availability when the season begins.

Does an online search give me the answer? Search results can be a starting point, but they rarely account for your baby’s age, your dose and your full medication list. Use them to form questions, then ask a professional.

Ask Pharmasave Remembrance before you choose

Breastfeeding and looking after your own health are not competing goals. With the right information, most nursing parents can treat their conditions and keep feeding their babies.

If you have a question about a medicine, call (905) 843-3232 or visit us at 645 Remembrance Road, Unit B103 & B104, Brampton, ON L7A 3H2. Our contact page lists store details, and the booking page lets you request a longer conversation if you have several medicines to go over.

The information here is general in nature. Speak with your pharmacist, doctor or your baby’s healthcare provider about any medicine you plan to use while breastfeeding.