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Naproxen and Breastfeeding

Naproxen is frequently used as an anti inflammatory and to add pain relief for instance after surgery. However, there seems to be concern about prescribing it for the breastfeeding mother. I hope this information helps.

Naproxen and Breastfeeding factsheet

If it was useful maybe you need to buy the book?

High Dose Vitamin D Supplements and Breastfeeding

The question as to the compatibility of high dose vitamin d supplements in the breastfeeding mother is a frequently asked question. We appear to monitor levels more frequently than we did in the past but research is difficult to source. I hope this information helps.

High dose vitamin d supplement for breastfeeding mothers factsheet

Oral Terbinafine and breastfeeding

Some mothers develop fungal nail infections in pregnancy and delay treatment. When breastfeeding, topical treatments are preferable. I am asked at least once a week about oral terbinafine – hard to answer with little research. Hope this information helps with shared decision making.

Oral terbinafine and breastfeeding factsheet

email wendy@breastfeeding-and-medication.co.uk

Nausea and Breastfeeding

One of the more frequently asked questions recently relates to nausea and even vomiting when breastfeeding. It may be due to norovirus, pregnancy (see https://breastfeeding-and-medication.co.uk/thoughts/suffering-from-morning-sickness-and-still-breastfeeding ) or to stop nausea from medication e.g morphine.

I hope this factsheet provides some options. The information is taken from my book Breastfeeding and Medication which provides more details and references. Maybe you need to buy a copy?

Nausea and Breastfeeding

Anxiety and breastfeeding – need to take a drug to relieve symptoms

I was very proud to have co written a fact sheet for BfN on anxiety and breastfeeding which affects so many new mothers. Beth is a CBT therapist and approached the treatment with non pharmacological methods available via IAPT and IESO (although with a waiting list sadly for most).

I looked at the relief of symptoms with long-term treatments such as SSRI drugs e.g. sertraline, citalopram, fluoxetine and paroxetine. Mothers may also be helped with propranolol to relieve palpitations and racing heart.

Recently there have been more requests from mothers with anxiety or post traumatic stress to take benzodiazepine to reduce symptoms or to treat a panic attack. Occasional use might be acceptable with monitoring of the baby for drowsiness and effective feeding. However, regular use is not encouraged – particularly of diazepam – because of its long half life and potential to accumulate in breastmilk and the baby, but also because this family of drugs is addictive with as little as 28 days treatment.

I have written this factsheet to provide as much information as possible on the use of anxiolytics diazepam, loprazolam and alparazolam during breastfeeding.

anxiolytics and breastfeeding factsheet

The information is taken from Breastfeeding and Medication which includes full references . Please consider buying the book if this information is useful

Breastfeeding and Oestrogen cream or pessary

Oestrogen creams and pessaries seem to be prescribed with increasing frequency to breastfeeding women to help with healing of sutures, prolapses or for ongoing vaginal dryness. There is little research evidence to guide a discussion of compatibility with breastfeeding.

Breastfeeding does seem to have an effect on natural vaginal lubrication for some and basics products such as KY Jelly®, Replens®, Sylk® and other products may help.

But for others oestrogen creams may be prescribed by the GP or an obs and gynae consultant.

It is known that vaginal absorption of oestrogen results in measurable amounts in milk (LactMed, Hale).

In Nielson’s study 6 lactating mothers were given vaginal suppositories (pessaries) containing 50 or 100 mcg of oestradiol. Levels of oestradiol were measurable in milk whilst before application of the pessaries the levels was below that of detection. According to Nielson a ratio of transfer of estradiol from plasma to milk during physiologic conditions is calculated to be less than 100:10. Peak levels were found in milk between 3 and 11 hours after application but was inconsistent and irrelevant with ongoing use. Outcome data is not given in the data that I have been able to access.

Nilsson S, Nygren KG, Johansson ED. Transfer of estradiol to human milk. Am J Obstet Gynecol. 1978;132:653-7.

Hale says vaginal absorption is greater than oral and quotes Chollet who studied atrophic vaginitis in post menopausal women. It is unclear what relevance this has to brestfeeding

Chollett J. A., G. Carter, et al. (2009). “Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis.” Menopause 16(5): 978-983.

Levels of oestradiol in the 2 most commonly used products are:

Ovestin – One applicator-dose contains 0.5 mg estriol.

Vagifem contains 10 mcg estradiol per vaginal tablet

neither product is licensed to be used in lactation.

Anecdotally some mothers have reported that their supply has dropped but by no means everyone.

Hypertension (raised blood pressure) and Breastfeeding

Many mothers experience raised blood pressure it seems. Is this due to our busy lifestyles, more mums giving birth at an older age? Who knows but it causes a lot of confusion. The drug normally initiated if a mother has symptoms of pre-eclampsia is labetolol. It is usually continued after delivery until the BP has settled. Virtually none passes into breastmilk. However, some mothers with poor circulation may notice sore, white nipples where the supply to the tip is decreased . If this happens the drug may need to be changed. Prolonged high BP in pregnancy can lead to restricted growth of the baby who may be born sleepy. Rather than just monitoring blood glucose levels the baby should be helped to attach to the breast and feed regularly or be given colostrum by spoon or syringe. A drop of colostrum can work magic.

Later blood pressure rises can be treated with enalapril, amlodipine and felodipine which are all compatible with breastfeeding according to expert sources. The NICE Guidelines NG 133 (2019) can also guide good practice.

The data for this fact sheet is taken from my book Breastfeeding and Medication which provides more detail and references to studies. Please consider buying a copy for future reference.

Hypertension and breastfeeding factsheet

Breastfeeding after VQ scans

One of the questions that frustrates me is “Can I continue to breastfeed immediately after a VQ scan, they think I may have a clot on my lungs? I’ve been told I have to stop feeding for 12 hours”. Most of these mothers have very young babies – often under 2 weeks so to dump that precious milk for 12 hours is really tough. There hasnt been enough time to build up expressed milk so necessitates the use of formula and a very premature end, against mum’s wishes usually, to exclusive breastfeeding.

The evidence is really hard to find. One option is to request a CT scan after which breastfeeding can continue as normal. The #dontsaystoplookitup poster refers just to CT and MRI scans and not to VQ scans

This information is from my book “Why Mother’s Medication Matters”

Breastfeeding and VQ scan

Timing of breastfeeds if taking medication

I’ve recently had several emails/ Facebook messages that mothers have been advised to pump and dump their breastmilk for a period of time after taking medication in order to minimise / prevent exposure of the baby to the drug. This has often been undertaken when the drug is compatible with breastfeeding and resulted in the unnecessary exposure of the baby to formula milk.

For most drugs taken for more than 3 days the amount in milk is constant across 24 hours. So timing feeds with respect to breastfeeding or dumping of the breastmilk is pointless. The half life of a drug is very important but just one of the factors in determining the compatability with normal breastfeeding. If you want to know more please consider buying “Breastfeeding and Medication”

Timing of medication and breastfeeds

Pain relief after birth and breastfeeding

I was recently asked for input in a guideline on pain relief for new mothers after birth. I was surprised to see it almost seemed to penalise breastfeeding mothers suggesting that if you are breastfeeding you cant have effective pain relief for more than 3 days even if you have had a c section. With a new grandchild due in June I decided to put together this information. It includes pain relief, laxatives, haemorrhoidal treatment and iron supplements

Pain relief after birth

Codeine and breastfeeding