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Pregnancy Bliss | Reproductive Health Hub

‘Heart’ drugs and breast-feeding

What about digoxin?
Some people with heart trouble are prescribed long-term digoxin. This is safe.

Does the same apply to amiodarone?
No. Amiodarone contains iodine and is therefore unsafe to use if breast-feeding.

Epilepsy drugs in breast-feeding
Epilepsy needs continuous treatment. What is the status of anti-epileptics regarding breast-feeding?
The most common anti-epileptics (or anticonvulsants, as they are better known) include Phenytoin, Carbamazepine and Sodium valproate (Valproic acid). These are known to be safe. Phenytoin very occasionally causes sedation of the baby. If this happens, temporary suspension of breast-feeding is advised. If, on resuming breast-feeding 36 – 48 hours later, the problem recurs, then options should be re-evaluated.

Ethosuximide (Emeside®, Zarontin®) another anticonvulsant, should not be used with breast-feeding. It causes hyper-excitability in the baby.

Relatively newer anti-epileptics, including Vigabatrin (Sabril®) and Lamotrigine (Lamictal®), remain a largely unknown quantity as far as breast­feeding is concerned. The mother will need to make a choice between breast-feeding and using the drug. If she is keen to breast-feed and she is on one of these, then she will need to liaise with her doctor to explore the possibility of being switched to another drug of proven safety.

Contraceptives and breast-feeding

Regarding contraception, where does "the pill" stand?
The combined pill containing both estrogen and progesterone cannot be used for contraception if one is to breast-feed. This is not because of any direct adverse effect to the baby. Rather, it is because the estrogen component of the pill will drastically reduce lactation, making breast­feeding impractical.

The progesterone-only pill (POP), popularly known as the "mini­-pill", is OK to use and is one of the recommended contraceptives for those who want to breast-feed.
Examples of the mini-pill include:
Endometriosis medication
What about Danazol, used to treat endometriosis?
Danazol is one of the older drugs used for endometriosis. It is not in much use any more. Danazol cannot be used during the period of breast-feeding.  
In any case, the need is unlikely to arise.  This is because endometriosis goes into remission during pregnancy and this remission is sustained during the period of breast-feeding.   

Last update: March 28, 2013