Use Of Drugs During Breast Feeding

Some drugs are secreted in breast milk. They are not required for the baby and may be harmful. The quantity of most drugs excreted in breast milk is less than 10% of the therapeutic dose in children. As a general rule breast feeding should not be done for 2 hours after taking a drug. 90% of patients with rheumatoid and other inflammatory arthritis suffer a disease flare within 3 months of delivery. It may be prudent to stop feeding child early, in case of need to start contraindicated drugs for patients with nonresponsive arthritis. It must be kept in mind that optimal disease control is essential for prevention of deformities. A disabled mother due to deformed joints will certainly be unable to bring up her child well.

Recommendations on use of drugs during breast feeding are given in following table.

  Drug Remark
1 Paracetamol Safe. Feed after 2 hours.
2 Anti-inflammatory Painkillers Safe/no substantial information. Ibuprofen, Indomethacin, Diclofenac, Naproxen are compatible. Ibuprofen is best choice.
3 Steroids No adverse effects on children upto 10 mg/day. Glucocorticoids, Prednisone preferred. Less than 0.1%excreted in milk.
4 Hydroxychloroquin Safe.2% of dose excreted in milk.
5 Sulphasalazine Safe. Caution in premature babies and in infantile jaundice.
6 Methotrexate No reported risk.0.02% dose ingested by child. Do not feed for 9 hours after tablet. Monitor the child.
7 Leflunomide No data about secretion in milk. Avoid if possible.
8 Azathioprine Safe. Almost undetectable in milk. No evidence of adverse effects in infants. Monitor the child.
9 Cyclophosphamide No data. Avoid if possible.
10 Mycophenolate Avoid.
11 Biologic drugs Insufficient data. Small amounts in breast milk. Avoid if possible.