Medicines and breastfeeding
About medicine use
Medicine use for breastfeeding women
Health providers and consumers are often unsure about the safety of medicines when a woman is breastfeeding. Fear of medicines is increasingly leading women to stop breastfeeding unnecessarily. Most medicines can be used safely during breastfeeding at the recommended dose, but there are exceptions that necessitate caution.
Medicine use for breastfeeding women is an ongoing research topic at the Judith Lumley Centre. Several research projects have been undertaken over time.
Professor Lisa Amir has published a number of articles on this topic, including an open access book chapter (Medicines for breastfeeding women: risky business? [external link]). Her most recent article addresses ethical issues around medication and lactation. (See the publications tab on this page). Recent PhD graduate, Dr Moni Rani Saha, is working with Prof Amir, Dr Luke Grzeskowiak (University of Adelaide) and Professor Hedvig Nordeng (University of Oslo) to analyse data from the Norwegian Mother and Baby cohort study. Several papers are in preparation.
Professor Lisa Amir has published an evidence-based guide to use of medicines for breastfeeding women (Amir et al 2011), which is available on the RACGP website [external link]. Important points:
- Most medicines are safe for use by breastfeeding women. If a medicine is safe to use in infants, it will generally be safe to use in breastfeeding women.
- Only a small number of drugs are contraindicated during breastfeeding.
- The risks and benefits of each medicine for the mother and the infant need to be evaluated.
- Drugs with short half-lives, high protein binding, low oral bioavailability or high molecular weight should be chosen.
Breastfeeding and COVID-19
On 3 February 2021 the Australian Breastfeeding Association brought experts together to provide updated information to health professionals who care for women, families and their babies, regarding breastfeeding in the context of COVID-19 and considerations around the vaccination for women who are breastfeeding. You can access this training for health professionals on the ABA's website (at no cost).
Professor Lisa Amir's talk was titled COVID-19 vaccination and breastfeeding: What do we know so far?
- Women missing from clinical drug/vaccine trials
- Breastfeeding and pregnancy should be considered separately
- COVID 19 vaccines probably safe for breastfeeding women and their infants
You can access the presentation slides here [pdf 1.56 MB]
Amir LH, Grzeskowiak LE, Kam RL. Ethical issues in use of medications during lactation. J Hum Lact 2020; 36(1):34-9. Available from: https://doi.org/10.1177/0890334419888156
Grzeskowiak L, Amir L, Ingman W. Domperidone can boost breast milk supply – here’s what you need know. The Conversation, 15 March 2018 . https://theconversation.com/domperidone-can-boost-breast-milk-supply-heres-what-you-need-know-88648
Grzeskowiak LE, Amir LH, Smithers LG. Longer-term breastfeeding outcomes associated with domperidone use for lactation differs according to maternal weight. Eur J Clin Pharmacol 2018; 74(8):1071-5. Available from: https://doi.org/10.1007/s00228-018-2470-0
Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of Serotonin Reuptake Inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol 2018; 84(6):1373-9. Available from: http://dx.doi.org/10.1111/bcp.13575
Grzeskowiak LE, Smithers LG, Amir LH, Grivell RM. Domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants: a systematic review and meta-analysis. BJOG 2018; 125(11):1371-8. Available from: https://doi.org/10.1111/1471-0528.15177
Blandthorn J, James K, Bowman E, Bonomo Y, Amir LH. Two case studies illustrating a shared decision-making approach to illicit methamphetamine use and breastfeeding. Breastfeed Med 2017; 12(6):381-5. Available from: https://doi.org/10.1089/bfm.2017.0010
Gilmartin CE, Amir LH, Ter M, Grzeskowiak LE. Using domperidone to increase breast milk supply: a clinical practice survey of Australian neonatal units. JPPR 2017; 47(6):426-30. Available from: http://dx.doi.org/10.1002/jppr.1289
de Ponti M, Amir LH, Stewart K, et al. Medicine use and safety whilst breastfeeding: investigating the perspectives of community pharmacists in Australia. Aust J Primary Care 2015;21(1):46-57. Available from: http://dx.doi.org/10.1071/PY13012.
Amir LH, Ryan K, Barnett C. Delphi survey of international pharmacology experts: an attempt to derive international recommendations for use of medicine in breastfeeding women. Breastfeed Med 2015; 10(3):168-74. Available from: http://dx.doi.org/10.1089/bfm.2014.0144
Amir LH. It's time for pharmacists to increase their support for breastfeeding (Editorial). Journal of Pharmacy Practice and Research 2015;45(1):7-8. Available from: http://dx.doi.org/10.1002/jppr.1072.
Grzeskowiak LE, Amir LH. Pharmacological management of low milk supply with domperidone: separating fact from fiction. Med J Aust [Letter] 2015; 202(6):298. Available from: https://dx.doi.org/10.5694/mja14.01585
Grzeskowiak LE, Amir LH. Use of Domperidone to increase breast milk supply: further consideration of the benefit-risk ratio is required. J Hum Lact [Letter] 2015; 31(2):315-6. Available from: http://doi.org/10.1177/0890334414567895
Grzeskowiak LE, Amir LH. Pharmacological management of low milk supply with domperidone: Separating fact from fiction. Med J Aust 2014;201(5):257-58. Available from: http://dx.doi.org/10.5694/mja14.00626.
Amir LH, Ryan KM, Jordan SE. Avoiding risk at what cost? Putting use of medicines for breastfeeding women into perspective. Int Breastfeed J 2012;7:14. Available from: http://dx.doi.org/10.1186/1746-4358-7-14.
McDonald K, Amir LH, Davey M-A. Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals. BMC Public Health 2011;11(Suppl 5):S5. Available from: http://dx.doi.org/10.1186/1471-2458-11-S5-S5.
Amir LH, Pirotta MV, Raval M. Evidence-based guidelines for use of medicines by breastfeeding women. Aust Fam Physician 2011;40(9):684-90.Available from: www.racgp.org.au/afp/201109/44172.
Jayawickrama HS, Amir LH, Pirotta M. GPs' decision making when prescribing for breastfeeding women: Content analysis of a survey. BMC Res Notes 2010;3:82. Available from: http://dx.doi.org/10.1186/1756-0500-3-82.
Amir LH. Medicines for breastfeeding women: risky business? In: Nueland WG, ed. Breastfeeding: Methods, Benefits to the Infant and Mother and Difficulties. Hauppauga, NY: Nova Publishers, 2010:129-41. Available from: https://www.novapublishers.com/catalog/product_info.php?products_id=15585. [open access book chapter]
Amir LH, Pirotta MV. Medicines for breastfeeding women: a postal survey of general practitioners in Victoria, Australia. Melbourne: Mother & Child Health Research, La Trobe University 2010.
Full report [PDF 2.75MB]
Amir LH, Pirotta MV. Medicines for breastfeeding women: a postal survey of general practitioners in Victoria (Letter). Med J Aust 2009;191(2):126. Available from: https://www.mja.com.au/journal/2009/191/2/medicines-breastfeeding-women-postal-survey-general-practitioners-victoria.
Amir LH. Medicines and breastfeeding: information is available on safe use (Letter). Med J Aust 2007;186(9):485. Available from: https://www.mja.com.au/journal/2007/186/11/medicines-and-breastfeeding-information-available-safe-use.