Adverse reactions in infants from maternal
drug ingestion depend largely on the amount of milk consumed by the infant, timing of breastfeeding in relation to dosing, dose of the medication, dosing interval, and
duration of therapy. When taking medications, breastfeeding mothers should be instructed to take their medication after breastfeeding, at the lowest effective dose and for the shortest duration. Overall, there are few data from human studies on the use of
antihistamines,
decongestants, and
cough products during breastfeeding. Studies of
pseudoephedrine, triprolidine, and
loratadine in humans conclude that low levels of each
drug would reach a breastfed infant. Since
triprolidine and
pseudoephedrine are also considered compatible with breastfeeding by the
AAP, these 2 drugs should be the first-line choices.
Codeine is considered compatible with breastfeeding by the
AAP, and would be an acceptable choice for short-term use as a
cough suppressant. It is important to note that many of the liquid
cough and cold products contain alcohol. In addition, many of the combination products are a mixture of an
antihistamine and a
decongestant and may also contain
aspirin,
acetaminophen,
ibuprofen, or
caffeine. It is preferable for nursing mothers to only take medications that are necessary and to avoid such combination products. The
AAP considers alcohol,
acetaminophen,
ibuprofen, and
caffeine compatible with breastfeeding.
Aspirin has been associated with significant negative effects on some nursing infants, and the
AAP recommends giving
aspirin to nursing mothers with caution. Mothers taking
cough and cold products should watch for adverse events in their breastfed infants. Infants may experience paradoxical central nervous stimulation from
antihistamines and irritability and
insomnia from
decongestants.