Anti-emetics use when breast-feeding
In case of nausea or vomiting, Metoclopromide (Maxolon®) is commonly prescribed. Is it safe?
Metoclopromide is one of the few drugs that are actually concentrated in breast-milk. It can make the baby sleepy but no other adverse effect has ever been reported. Since it is usually used for a very short time, the advice is to err on the side of caution by suspending breast-feeding during its use.
What about the other drugs used for nausea and vomiting such as Prochlorperazine (Stemetil®) or Cyclizine (Valoid®)?
Specific information as to their effects in this situation is not available and therefore they are rarely prescribed to breast-feeding mothers. When they are, breast-feeding will often be suspended, purely as a precaution.
Laxatives and breast-feeding
Laxative use may be necessary sometimes while breast-feeding. What about them?
There are two broad categories of laxatives: those that are absorbed and those that are not (bulk laxatives).
Bulk laxatives are safe (they won't get to the baby in any way) but absorbable laxatives should always be avoided. The mother should check which category the prescribed laxative falls into.
Examples of bulk (safe) laxatives include Isphagula husk (Fybogel®, Isogel®, Fibrelief®, Ispagel Orange®, Regulan®), Methylcellulose (Celevac®), Sterculia (Normacol®) etc.
Painkillers (Analgesics) use while breast-feeding
Painkillers are often necessary. Which are safe and which aren't?
Paracetamol (Acetaminophen) is the most common painkiller. It is found in very small quantities in breast-milk and there is no risk of it accumulating in the baby's circulation. It is safe.
Aspirin is a good analgesic but its use with breast-feeding is not advised. This is because modest amounts are found in milk and concentrations in the baby could reach a high level. There is a risk, admittedly exceedingly small, of Reye's syndrome, which causes brain and liver damage. This condition though rare, is extremely dangerous and could be fatal.
What about Diclofenac (Voltarol®)?
This is safe to use while breast-feeding. So are Ibuprofen (Brufen®) and Mefenamic acid (Ponstan®).
What about Indomethacin?
One of the more common painkillers and anti-inflammatories, Indomethacin is probably safe. However, because of its potency, if used, the baby should be observed carefully for any possible adverse effects.
Suppose strong painkillers such as Morphine or Pethidine need to be used?
This will almost certainly be for a very short time, probably 24 hours or less.
In normal doses and for such limited use, morphine is perfectly safe.
When Pethidine is administered, the baby should be observed closely if being breast-fed, because he or she may become drowsy. This is accentuated by the fact that the drug is not eliminated from the baby's body as efficiently and effects tend to linger.