Breastfeeding and Medicines, Alcohol, Caffeine and Cannabis

Most medicines are fine

• Most common medicines pass into milk only in small amounts and are compatible with breastfeeding. Stopping breastfeeding is rarely needed.
• Always tell the prescriber, dentist or pharmacist that you're breastfeeding and how old the baby is. Newborns and premature babies clear medicines more slowly.
• LactMed, a free government database, lists research on specific medicines. A pharmacist or your baby's pediatrician can help you read it.
• Usually fine: acetaminophen and ibuprofen for pain, most antibiotics, many antidepressants, allergy medicines that don't cause drowsiness, inhalers, insulin, thyroid medicine, local numbing at the dentist, and most vaccines.

Ones to check first

• Codeine and tramadol: the FDA advises against them while breastfeeding because a few babies get dangerous levels.
• Decongestants containing pseudoephedrine can lower milk supply.
• Estrogen birth control may reduce supply in some people (see the sex and birth control guide).
• Herbal products and supplements aren't well tested or regulated, including ones sold to boost milk. Ask before using them.
• Opioid pain medicine after birth: short courses are usually fine; watch the baby for unusual sleepiness or limpness.

Procedures and tests

• After most anesthesia you can breastfeed as soon as you're awake and alert.
• Most imaging contrast doesn't require pumping and dumping. Ask the radiology team.

Caffeine

• Up to about 300 mg a day, roughly 2-3 cups of coffee, is generally fine.
• Young or premature babies may get jittery or wakeful with more. Remember tea, cola, energy drinks and chocolate count too.

Alcohol

• Not drinking is the safest choice. If you do, the CDC suggests no more than one standard drink a day, and waiting at least 2 hours after that drink before nursing.
• Alcohol leaves milk as it leaves your blood. Pumping and dumping doesn't speed this up; it only helps comfort if you're full.
• Alcohol can slow letdown and make babies sleep worse.
• After drinking, never bed-share or fall asleep on a sofa with the baby, and have a sober adult on hand.

Cannabis, nicotine and other drugs

• The AAP and ACOG advise against cannabis while breastfeeding. THC builds up in milk and can stay for days or weeks.
• If you smoke or vape nicotine, breastfeeding is still usually better than formula. Never smoke near the baby or in the car or home, and change clothes after.
• If you're in treatment for opioid use disorder with methadone or buprenorphine and stable, breastfeeding is generally encouraged.

When to check in

• Ask your baby's pediatrician or a pharmacist before starting a new medicine or supplement, and if the baby seems unusually sleepy, fussy or feeds poorly after you start one.
• If the baby is very hard to wake, limp or breathing slowly, call 911.