How long should i pump and dump after taking medication

Q: Should I pump and dump after medications?

Theres usually no need to pump and dump when taking medication, but check with your pharmacist or healthcare provider about the safety of any medication while breastfeeding.

Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. Few medications are contraindicated while breastfeeding.

Table of Contents Show

Is it safe for mothers to use prescription medications while breastfeeding?
Where can I search for specific medications and their safety in mothers while breastfeeding?
How long after Medication Can I breastfeed?
Should I pump and dump after medications?
How long should I pump and dump after taking antibiotics?
Can medications be excreted through breast milk?

Note to Breastfeeding Mothers

Tell your health care provider and your baby’s provider about any medications or supplements you are taking, including vitamins, herbs, and over-the-counter products.

Is it safe for mothers to use prescription medications while breastfeeding?

Usually. A 2013 clinical report by the American Academy of Pediatrics (AAP), “The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics,external icon” indicates that most medications and immunizations are safe to use during lactation.

According to the AAP, health care providers should weigh the risks and benefits when prescribing medications to breastfeeding mothers by considering the following:

Need for the drug by the mother.
Potential effects of the drug on milk production.
Amount of the drug excreted into human milk.
Extent of oral absorption by the breastfeeding infant.
Potential adverse effects on the breastfeeding infant.
Age of the infant.
Proportion of feedings that are breast milk.

Review LactMed®external icon for the most up-to-date information available on medications and lactation when advising breastfeeding mothers on medication safety.

Note to Breastfeeding Mothers

Tell your health care provider and your baby’s provider about any medications or supplements you are taking, including vitamins, herbs, and over-the-counter products.

Where can I search for specific medications and their safety in mothers while breastfeeding?

The US National Library of Medicine (NLM) at the National Institutes of Health (NIH) maintains LactMed®external icon, a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed.

LactMed®external icon includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data come from scientific literature and are fully referenced. A peer review panel reviews the data for scientific validity and currency.

The Organization of Teratology Information Specialists (OTIS) provides information, in English and Spanish, for women and health care providers on the risks and safety of taking medication during pregnancy and breastfeeding. This group maintains a website called Mother to Babyexternal icon.

The InfantRisk Centerexternal icon provides up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding. The InfantRisk Center also provides resources such as a free call center, MommyMeds mobile app for consumers, and InfantRisk mobile app for health care professionals.

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Consider this excerpt from The American Academy of Pediatrics Clinical Report: “Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants.”11

The preface of Medications and Mothers’ Milk by Hale & Rowe states, “The risks of formula feeding are significant and should not be trivialized. Few drugs have documented side effects in breastfed infants, and we know most of these.”7

Before you start wondering…
"If I take this medication, then pump and dump, is it then safe to breastfeed my baby?"
"If I take this medication and it’s not safe to breastfeed, should I pump and dump the milk?"
It’s always best to check a resource, talk to your doctor and International Board Certified Lactation Consultant (IBCLC) about your options before doing anything unnecessary like dumping your precious breastmilk!

Many factors impact drug entry into breastmilk and are referred to as “kinetic factors”. Pharmacokinetics means bodily absorption, distribution, metabolism, and excretion of drugs.9 Kinetic factors include lipid solubility, molecular size, blood level, protein binding in maternal circulation, oral bioavailability and half-life.6
It sounds very complicated, but it doesn’t have to be!

Look it up, talk to your doctor and IBCLC.

Infant Risk Center at Texas Tech University or 806-352-2519
LactMed U.S. National Library of Medicine

General tips when you have a cold or the flu

Try non-pharmacologic treatments first - fluids, vitamin C rich foods, rest, saline, humidifier.
If medications are needed, use single-ingredient drugs, not combo drugs, short-acting vs long-acting and take immediately after nursing.6
Caution for late-stage lactation with pseudoephedrine due to possible dip in milk supply.7
Use codeine with caution due to rapid metabolizers. (Women with this genetic profile have higher levels of active medication which can pass into breastmilk.)7

Medication Smart Practices

Do I need to take this now?
Have I checked my resources and talked to my doctor about my concerns?
Is there an alternative?
Is it an option to take immediately after nursing?
If the medication is not compatible with breastfeeding, ask your doctor what would be the recommended medication if the baby had this condition.

What about pumping and dumping after consuming alcohol?

The dose of alcohol in milk is low (less than 16% of mothers dose).1
Alcohol levels in milk peak at around 30-60 mins after consumption and then decrease quickly if no more is consumed.1
Pumping won’t speed up the elimination of alcohol from milk.8

Alcohol Consumption Smart Practices

If you want to drink, have one right after a nursing or pumping .
Pump if you’re going to miss a feeding and/or for comfort.
Simple guideline to follow: if you’re fine to drive you’re fine to breastfeed.
Only about 2% of the alcohol ingested by the mother reaches her blood and milk.

Considerations

An extremely important factor to consider when drinking alcohol is your ability to care for your baby.
Alcohol can make baby sleepier and can change the taste of your breastmilk.
Alcohol test strips that are available in stores can cause moms more stress because they show positive with any alcohol in your system and are known to also show false positives.

Dental Procedures

Academy of Breastfeeding Medicine’s Protocol #15 Analgesia and Anesthesia for the Breastfeeding Mother states, “Local anesthetics such as lidocaine, bupivacaine, and ropivacaine can be safely used in breastfeeding mothers.”10
According to Medications and Mothers’ Milk by Hale & Rowe, nitrous oxide (laughing gas) is rapidly eliminated from body and rapid recovery is within 3-5 minutes and ingestion of nitrous oxide orally is unlikely.7

Surgery Requiring General Anesthesia?
American Association of Nurse Anesthetists (AANA), “Many studies have found that the use of general anesthesia and most commonly used medications for pain relief are safe and should not interfere with breastfeeding because only minimal traces of the anesthetic are passed on through the breast milk," said Janice Izlar, CRNA, DNAP. “A nursing mother should be allowed to breastfeed as soon as she is awake and aware after general anesthesia.”5

What about X-Rays, MRI, Contrast, CAT scans, Ultrasounds, and Mammograms?

All of these imaging modalities are compatible with breastfeeding. 4
With contrast media and/or sedation for imaging, the half-life of the medication is key; find out what medications will be used, check your resources, and speak with your physician.
A lactating breast is dense, which may make interpretation of mammograms more difficult.

Cancer

Breastfeeding with cancer will not give the baby cancer.2
Chemotherapy is, as a general rule, NOT compatible with breastfeeding.2
It is sometimes possible to pump and dump to maintain production and resume direct breastfeeding or breastmilk feeding after chemotherapy is completed.

Wondering when breastfeeding is not advisable?
To sum up the CDC’s article, it is not advisable if the infant is diagnosed with galactosemia. The CDC also advises against breastfeeding if the infant’s mother has been infected with human immunodeficiency virus (HIV), is taking antiretroviral medications, has untreated active tuberculosis, is infected with human T-cell lymphotropic virus I or II, or takes illicit drugs. In addition, taking cancer chemotherapy agents (antimetabolites), or undergoing radiation therapies may require a temporary interruption in breastfeeding.3

References

Alcohol and breastfeeding. (n.d.). Retrieved February 12, 2018, from https://www.infantrisk.com/content/alcohol-and-breastfeeding
Breast cancer & pregnancy. (n.d.). Retrieved January 18, 2018, from https://my.clevelandclinic.org/health/diseases/9010-breast-cancer-during...
Breastfeeding. (2016, November 18). Retrieved January 18, 2018, from https://www.cdc.gov/breastfeeding/disease/
Department of radiology & biomedical imaging. (n.d.). Retrieved January 18, 2018, from http://radiology.yale.edu/patientcare/policies/breastfeeding.aspx
Does anesthesia affect a new mom’s ability to breastfeed? (n.d.). Retrieved January 18, 2018, from https://www.aana.com/patients/does-anesthesia-affect-a-new-mom-s-ability...
Hale, T. W. (n.d.). Early Postpartum. Retrieved January 18, 2018, from https://www.infantrisk.com/content/drug-entry-human-milk
Hale, T. W., & Rowe, H. E. (2017). Medications & mothers milk 2017. New York, NY: Springer Publishing Company, LLC
LaFleur, E. (2016, March 11). Breastfeeding and alcohol: is it OK to drink? Retrieved February 12, 2018, from https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/e...
Pharmacokinetics. (n.d.). Retrieved January 18, 2018, from https://www.merriam-webster.com/dictionary/pharmacokinetics
Reece-Stremtan, S., Campos, M., & Kokajko, L. (2017). ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother. Breastfeeding Medicine,12(9), 1-7. doi: 10.1089/bfm.2017.29054.srt https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/15-analgesia-and...
Sachs, H. C. (2013, September 01). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Retrieved January 18, 2018, from https://pediatrics.aappublications.org/content/132/3/e796

How long after Medication Can I breastfeed?

Drugs to relieve headache, aches, pain or fever Try not to breastfeed for 1 to 2 hours after taking the dose to minimise the amount in your breastmilk.

Should I pump and dump after medications?

There's usually no need to pump and dump when taking medication, but check with your pharmacist or healthcare provider about the safety of any medication while breastfeeding.

How long should I pump and dump after taking antibiotics?

The good news is that the use of antibiotics is generally safe when breastfeeding, and does not necessitate the need to 'pump and dump' or to cease breastfeeding. According to Australia's National Health and Medical Research Council: 'It is safe to continue breastfeeding when taking antibiotics'.

Can medications be excreted through breast milk?

Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. Few medications are contraindicated while breastfeeding.