One population always gives me pause when prescribing meds: pregnant and breastfeeding patients. Even after a decade in urgent care, the moment I hear “I’m breastfeeding,” my usual treatment plans go out the window. Suddenly, I’m double and triple-checking every prescription.
While pregnancy guidelines are well-established, figuring out what cold medicine to take while nursing or which cough medicine is safe while breastfeeding can be tricky. With limited research and conflicting recommendations, clinicians often find themselves second-guessing treatment choices.
I recently sat down with a physician who regularly treats lactating patients, and they shared their top tips for navigating these encounters:
The Good News
If a medication is safe for a baby to take directly, it’s generally safe for a breastfeeding mother, too. That means common options like acetaminophen, ibuprofen, and even some antibiotics fall into the safe zone. But when in doubt, lean on evidence-based resources.
Utilize your Resources
When in doubt, rely on evidence-based resources to determine medication safety.
Hale’s Medications and Mothers' Milk is a handy desk reference for clinicians created and maintained by pharmacists on safe medication practices during breastfeeding. It also comes in an app version for the on-the-go clinician.
Make Yourself a Cheat Sheet
Don’t be afraid to tackle your own weaknesses by giving yourself a reminder. Take some time to write down some of the conditions you see most often and preferred medications for breastfeeding moms. No need to try and remember or double-check yourself every single visit. Here is my go-to list:
Pain Management: Acetaminophen, ibuprofen, and most opioids (short-term, low-dose use).
Antibiotics: Penicillins, cephalosporins, and macrolides are generally safe.
Antidepressants: Sertraline and paroxetine have minimal transfer to breast milk.
Antihistamines: Loratadine and cetirizine are preferred over sedating antihistamines.