Many breastfeeding mothers need medications — whether for a headache, an infection, or a chronic condition. Uncertainty about what is safe can lead to avoiding medications you actually need, or in the worst case, stopping breastfeeding unnecessarily.

The good news: most medications are compatible with breastfeeding. The AAP and WHO both confirm that the benefits of breast milk far outweigh the risk of medication exposure to the baby in the vast majority of cases.

The main rule: Most medications are safe

Only a small proportion of medications pass into breast milk in amounts that can affect the baby. The AAP emphasizes that there is rarely reason to advise against breastfeeding when taking medications, as long as there is a sound medical assessment.

That said: never stop medication on your own because you're breastfeeding. Talk to your doctor or pharmacist first. Stopping necessary medication can be worse for you and your baby than continuing treatment.

Safe over-the-counter medications

Pain relievers

Acetaminophen (Tylenol, Paracetamol) is the first choice for breastfeeding mothers. The amount that passes into breast milk is very limited and causes no side effects in the baby. You can take normal doses: 325–650 mg every 4–6 hours as needed, not exceeding the daily maximum.

Ibuprofen (Advil, Motrin) is also safe. Very little ibuprofen transfers to breast milk. You can use normal doses as needed.

Naproxen (Aleve) can generally be used while breastfeeding in normal doses, though short-term use is preferred.

Avoid codeine-containing products (such as Tylenol with Codeine) with regular use while breastfeeding. Single doses may be used, but regular use over several days is not recommended for nursing mothers. Codeine converts to morphine in the body and can affect the baby.

Allergy medications

These antihistamines are safe while breastfeeding:

Cetirizine (Zyrtec)
Loratadine (Claritin)
Desloratadine (Clarinex)
Levocetirizine (Xyzal)
Fexofenadine (Allegra)

Very small amounts pass into breast milk, and no side effects in breastfed babies have been reported.

For nasal congestion

Nasal sprays with xylometazoline or oxymetazoline (Afrin) can be used safely while breastfeeding. Systemic decongestants like pseudoephedrine (Sudafed) should be avoided as they can reduce milk supply.

For sore throat

Throat lozenges with benzocaine or menthol are generally safe for breastfeeding mothers.

Antibiotics and breastfeeding

The vast majority of antibiotics commonly prescribed are compatible with breastfeeding. Common penicillins pass into breast milk in very small amounts and are safe to use at full dose while breastfeeding.

Your doctor will normally choose antibiotics that are compatible with breastfeeding. If you're unsure whether the antibiotic you've been prescribed is safe, ask your doctor or pharmacist, or check LactMed (the NIH's free database for drugs and lactation).

Some antibiotics may cause your baby's stools to be looser than usual. This is harmless and resolves when the course is finished. There is no reason to stop breastfeeding.

Medications that require individual assessment

Some medication groups require individual evaluation by a doctor:

Antidepressants (SSRIs)

Most antidepressants can be used while breastfeeding, but individual assessment should be made. For some medications (such as sertraline/Zoloft), there is extensive experience with use in breastfeeding mothers, and side effects in babies are very rare.

Stopping antidepressants without your doctor's advice can be harmful to you. Untreated depression affects both mother and baby negatively.

Epilepsy medications

Some epilepsy medications, such as lamotrigine (Lamictal), pass readily into breast milk. Your doctor should follow up with blood tests and monitor the baby.

Blood pressure medications

Most blood pressure medications can be used while breastfeeding, but some are preferred over others. Your doctor will adapt the treatment.

Medications to avoid while breastfeeding

Some medications are not recommended during breastfeeding:

Lithium (used for bipolar disorder) — passes readily into breast milk
Chemotherapy (cancer treatment) — even small amounts can affect the baby
Ergotamine (for migraines) — can reduce milk supply and affect the baby
Radioactive substances (used in certain diagnostic procedures) — temporary nursing pause required

The list above is not complete. Always check with your doctor or pharmacist before taking medications you're unsure about. Package inserts are often more restrictive than necessary and should not be your only source of information.

Package inserts vs. reality

Many breastfeeding mothers become frightened when they read the package insert, which often says "should not be used during breastfeeding" or "consult a doctor." The NIH's LactMed database explains that package inserts are often very restrictive for legal reasons.

The manufacturer typically has not conducted its own studies on breastfeeding women, and it takes a long time for package inserts to be updated with new knowledge. So the fact that a package insert advises against use does not necessarily mean the medication is harmful to the baby.

Use evidence-based sources like LactMed or ask your doctor instead.

LactMed — your best resource

LactMed is a free, publicly available database maintained by the National Institutes of Health (NIH). It provides up-to-date information on drugs and other chemicals to which breastfeeding mothers may be exposed, including information on the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant.

Other helpful resources

InfantRisk Center (infantrisk.com) — hotline and database for medications during pregnancy and breastfeeding
Breastfeeding Medicine — the Academy of Breastfeeding Medicine publishes clinical protocols
Your pediatrician or OB-GYN — always the best first call

Herbal remedies and supplements

Many people believe that "natural" means safe, but this is not always true. Herbal preparations and natural remedies are often less well-documented than approved medications.

Some herbal remedies to be cautious about:

St. John's Wort (can affect the efficacy of other medications and may cause infant sedation)
Echinacea (limited documentation during breastfeeding)
Large amounts of caffeine — one to two cups of coffee per day is fine, but avoid large amounts

Talk to your doctor or pharmacist before using herbal remedies while breastfeeding.

Timing of medications

For some medications, timing can reduce the amount the baby is exposed to:

Take the medication right after breastfeeding, so the concentration in blood (and milk) is lower at the next feeding
For acetaminophen and ibuprofen, this is unnecessary — the amounts in breast milk are very low regardless

Premature babies and newborns under 2 weeks are more sensitive to medications in breast milk than older babies. Tell your doctor your baby's age when discussing medication use.

Frequently asked questions

Can I take ibuprofen when I'm breastfeeding?

Yes. Ibuprofen (Advil, Motrin) is safe during breastfeeding in normal doses. Very little passes into breast milk, and no side effects in breastfed babies have been reported.

Do I need to pump and dump after taking medication?

For the vast majority of medications, this is unnecessary. Acetaminophen, ibuprofen, and common antibiotics do not require a nursing pause. For a few specific medications (such as radioactive contrast agents), a temporary nursing pause may be necessary — your doctor will inform you of this.

Can I have dental anesthesia while breastfeeding?

Yes. Local anesthesia for dental treatment is safe for breastfeeding mothers. Any amount that might reach breast milk is minimal.

Can I use topical pain-relief creams while breastfeeding?

Topical gels and creams with diclofenac (Voltaren) or ibuprofen are safe to use while breastfeeding. The amount absorbed into the bloodstream through the skin is very small. Avoid applying cream directly to the breasts.

Medications While Breastfeeding: What Is Safe?