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? [PDF 1.7MB). See the publications tab on this page for an open access article about ethical issues around medication and lactation. In collaboration with Professor Hedvig Nordeng (University of Oslo), we have published two articles about medication use in lactating women in the Norwegian Mother and Baby cohort study. In collaboration with Associate Professor Luke Grzeskowiak (Flinders University), we have conducted several studies about Australian women's use of galactagogues.
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.
McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir A, Grzeskowiak LE. Women's experiences with using domperidone as a galactagogue to increase breast milk supply: an Australian cross-sectional survey. Int Breastfeed J 2023; 18:11. https://doi.org/10.1186/s13006-023-00541-9
Grzeskowiak LE, Saha MR, Ingman WV, Nordeng H, Eivind Y, Amir LH. Incidence, antibiotic treatment and outcomes of lactational mastitis: Findings from The Norwegian Mother, Father and Child Cohort Study (MoBa). Paediatr Perinat Epidemiol 2022; 36(2):254-63.
Grzeskowiak LE, Saha MR, Nordeng H, Eivind Y, Amir LH. Perinatal antidepressant use and breastfeeding outcomes: Findings from The Norwegian Mother, Father and Child Cohort Study (MoBa). Acta Obstet Gynecol Scand 2022; 101 (3):344-54. doi: 10.1111/aogs.14324
McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir AK, Grzeskowiak LE. Knowledge of galactagogue use during breastfeeding in Australia: A cross sectional online survey. J Hum Lact 2022; 38(4):740–8 doi:
McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir AK, Grzeskowiak LE. Use and experiences of galactagogues while breastfeeding among Australian women. PLoS One 2021; 16(7):e0254049. DOI 10.1371/journal.pone.0254049
Zizzo G, Amir LH, Moore V, Grzeskowiak LE, Rumbold AR. The risk-risk trade-offs: Understanding factors that influence women's decision to use substances to boost breast milk supply. PLoS One 2021; 16(5):e0249599 DOI: 10.1371/journal.pone.0249599
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? [PDF 1.7MB]. In: Nueland WG, ed. Breastfeeding: Methods, Benefits to the Infant and Mother and Difficulties. Hauppauga, NY: Nova Publishers, 2010:129-41.
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.