Consumer Pregnancy and Lactation Question Collection

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Date Question  
Jan. 2, 2017I have a cold, and I'm wondering if I can rub peppermint oil on my feet? I am 22 weeks pregnant. details
 

Response: When used topically, I don't see a problem with it; but limited information available:

PREGNANCY AND LACTATION: LIKELY SAFE ...when used orally in amounts commonly found in foods. Peppermint has Generally Recognized as Safe (GRAS) status in the US. There is insufficient information available about the safety of using peppermint in medicinal doses during pregnancy or lactation; avoid using. (1)
References: (1) Natural Medicines Comprehensive Database

Jan. 2, 2017I think I have head lice. Will I be able to treat it while I'm breastfeeding my 8 month old? details
 

Response: Yes, permethrin is compatible with breastfeeding. When you go to the pharmacy tomorrow, tell the pharmacist that you are breastfeeding and they can help you select the appropriate treatment.
References: (1) RxTx
(2) lactmed

Jan. 3, 2017My wife is pregnant and has a cold sore. She is in her second trimester. What can she use? In the past she has used Valtrex. details
 

Response: Both Valtrex and Acyclovir are safe to use in pregnancy.

Adverse events were not observed in animal reproduction studies. Valacyclovir is metabolized to acyclovir. In a pharmacokinetic study, maternal acyclovir serum concentrations were higher in pregnant women receiving valacyclovir than those given acyclovir for the suppression of recurrent herpes simplex virus (HSV) infection late in pregnancy. Amniotic fluid concentrations were also higher; however, there was no evidence that fetal exposure differed between the groups (Kimberlin, 1998). Data from an acyclovir pregnancy registry has shown no increased rate of birth defects than that of the general population; however, the registry is small and the manufacturer notes that use during pregnancy is only warranted if the potential benefit to the mother justifies the risk of the fetus. Because more data is available for acyclovir, that agent is preferred for the treatment of genital herpes in pregnant women; however, valacyclovir may be considered for use due to its simplified dosing schedule. Pregnant women who have a history of genital herpes recurrence, suppressive therapy is recommended starting at 36 weeks gestation.
References: MedSask minor ailments guidelines
Lexicomp

Jan. 3, 2017Patient is 40 weeks pregnant with heartburn. Ranitidine is not working and she says she has tried all the non-pharmacological methods. What can she take for heartburn? details
 

Response: Gaviscon is an option - It is not absorbed systemically. An ant-acid like Tums are also safe.
References: 1. http://www.gaviscon.co.uk/heartburn-indigestion/pregnancy/

Jan. 3, 2017Is vortioxetine safe while breast feeding? details
 

Response: There is no data on (Trintellix) vortioxetine in breastfeeding in humans as the drug is fairly new.

Available data in animals have shown excretion of vortioxetine/vortioxetine metabolites in milk. It is expected that TRINTELLIX will be excreted into human milk. Because a risk to the nursing child cannot be excluded, breast-feeding is not recommended during treatment with TRINTELLIX.

A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from TRINTELLIX treatment, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.(1)

Patient was switched from Pristiq (desvenlafaxine succinate) recently. The child is one year old and feeds once or twice a day. In conjunction with her doctor and the mother's wishes, it may be time to wean the child. If not, sertraline is considered the best SSRI in lactation so that could also be an option.

Because of the low levels of sertraline in breastmilk, amounts ingested by the infant are small and is usually not detected in the serum of the infant, although the weakly active metabolite norsertraline (desmethylsertraline) is often detectable in low levels in infant serum. Rarely, preterm infants with impaired metabolic activity might accumulate the drug and demonstrate symptoms similar to neonatal abstinence. Most authoritative reviewers consider sertraline one of the preferred antidepressants during breastfeeding. Occasional mild side effects such as insomnia, restlessness and increased crying have ben reported in breastfed infants. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding and may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants. (2)
References: 1)RxTx
2)Lactmed

Jan. 3, 2017What can an 8 week pregnant woman use for a cold sore? details
 

Response: Valtrex/Acyclovir/Abreva/Lipactin/topical emollients.

Valtrex or acyclovir can be prescribed by a pharmacist and work better at first sign of tingle. All are safe to use.
References: MedSask Minor Ailments guidelines

Jan. 4, 2017I am 47 and 8 weeks pregnant. I have tooth pain and was prescribed Tylenol #3 in the past; can I take that tonight even though she is pregnant? details
 

Response: I can't suggest she take medication that wasn't prescribed for this present situation. Tylenol #3 contains codeine which is not absolutely safe to take in pregnancy. In the first trimester, reports of heart defects have been noted in moms that took codeine. An occasional dose may be OK to take but if your mom is prescribed this she will have to decide if the benefit outweighs the risk of taking the medication. For tonight, I would suggest Tylenol Extra Strength - 2 tablets this evening. If that is not enough pain control then to follow up with doctor or dentist.
References: Lexicomp online
Medications and Mothers' Milk - T. Hale, H. Rowe 2014

Jan. 4, 2017Am I able to take an occasional lorazepam (Ativan) for anxiety if I am breastfeeding? My baby is 2 months old. details
 

Response: It is OK to take Ativan 1mg once in awhile while breastfeeding.
It is safe to use a shorter acting benzodiazepine if for short term/intermittent use, low dose and infant is past first week of life.(1)

Lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is safely administered directly to infants. Evidence from nursing mothers indicates that lorazepam does not cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required. (2)
References: 1)Medications and Mothers' Milk - T. Hale, H. Rowe 2014
2)Lactmed online

Jan. 4, 2017I am breastfeeding my 3 month old and have a cold. I don’t normally take medications but it’s the 3rd day so am wondering if there is something I can safely take? details
 

Response: Her main symptoms are sore throat and nasal congestion. Advil for sore throat is compatible with breastfeeding and the safest decongestant would be to use a decongestant nasal spray such as Otrivin or Dristan. These may be used twice daily for no longer than 3 days. (little of this would pass to breastmilk when used intransally).
References: medSask - On call references

Jan. 6, 2017I get hives just about every evening and take Benadryl to relieve this. I am 5 weeks pregnant And wonder if this is harmful? details
 

Response: Taking Benadryl is not harmful: Diphenhydramine may be used for the treatment of allergic conditions in pregnant women when a first generation antihistamine is indicated (Babalola 2013; Murase 2014; Zuberbier 2014).(1)
My concern is that you need this every night. Withdrawal symptoms have been reported after the use of diphenhydramine throughout pregnancy (2). I would recommend discussing this with your physician/specialist.
References: 1- Up to Date
2- Drugs During Pregnancy and Lactation - Schaefer, Peters and Miller. P 58

Jan. 6, 2017I had morphine 2mg and an antibiotic which were given to me with IV fluids at 12:30 last night. Can I breastfeed now? details
 

Response: I can't speak about the antibiotic without knowing what it was (the Dr told her at the time she could breastfeed after) but in terms of the morphine, it is OK to go ahead with breastfeeding now. (1,2)
References: 1. Drugs in Pregnancy and Lactation - Briggs
2. Lexicomp online

Jan. 8, 2017I am 4 weeks pregnant and I have a migraine. Can I take Advil for the pain? details
 

Response: NSAIDS (ibuprofen, naproxen) are generally not recommended throughout pregnancy and especially in the last trimester. Some experts now discourage use anytime during pregnancy and around conception . (1, 2) I would recommend discussing options with your physician before treating with OTC medications.
References: 1- Pharmacists Letter 221112
2- Drugs during Pregnancy and Lactation

Jan. 8, 2017What can I use for constipation if I am 3 months pregnant? details
 

Response: Follow all the non- pharmaceutical things the nurse told you to do.
Safer meds to use are:
Metamucil - Not absorbed, considered first-line.
Increase dose slowly to avoid gas and use with plenty of water.
Lactulose - Very small amount absorbed,
- Risk probably negligible
- Use only short-term or occasionally to avoid maternal dehydration or electrolyte imbalance. (1)
Polyethylene glycol (PEG), either PEG-3350 (Restoralax, Laxaday)
Although the published human pregnancy experience is limited, the substances are compatible in pregnancy because only minimal amounts are absorbed without significant change in fluid or electrolyte balance. Several sources have concluded that polyethylene glycol (PEG), either PEG-3350 or PEG-4000 are safe and effective and should be considered as first-line therapy for constipation in pregnancy (2)
Glycerin suppositories are generally considered safe to use during pregnancy(3)
References: 1) Pharmacist Letter 221210
2)Drugs in Pregnancy and Lactation - Briggs
3)Lexicomp

Jan. 8, 2017I was prescribed Linessa (desogestrel—ethinyl estradiol) and wonder if this will affect my breastfeeding. details
 

Response: You are now 8 weeks postpartum and the Linessa has a low dose of estrogen (25mcg) so this would appear to be OK to use in breastfeeding.
Ethinyl estradiol in doses greater than 30 mcg daily can suppress lactation and lead to more supplementation and possibly earlier discontinuation of breastfeeding than nonhormonal or progestin-only contraception.

The weight of current evidence seems to indicate that combination oral contraceptives probably do not affect the composition of milk substantially in healthy, well-nourished mothers and do not adversely affect long-term infant growth and development.
Based on the available evidence, expert opinion in the United States is that postpartum women who are breastfeeding should not use combined hormonal contraceptives during the first 3 weeks after delivery because of concerns about increased risk for blood clots.
World Health Organization guidelines are more restrictive, stating that combined oral contraceptives should not be used in nursing mothers before 42 days postpartum. (1)
For women who are breastfeeding with no additional clot risk factors, combined hormonal contraception can be started 28 days (four weeks) postpartum. (2)
References: 1)Lactmed
2)UpToDate - Postpartum contraception

Jan. 9, 2017Can I use Hydrasense nasal wash while pregnant? It contains eucalyptus. Patient has a history of sinus infections and frequently requires antibiotics. details
 

Response: Occasional use should be fine. You can also get a plain saline nasal rinse that can be used as often as necessary with no risks.
If no improvement by end of week, recommend seeing your doctor.

PREGNANCY AND LACTATION: LIKELY SAFE …when used orally in amounts commonly found in foods.
There is insufficient reliable information available about the safety of medicinal amounts of eucalyptus oil. (1, 2)
References: (1) Natural Medicines Comprehensive Database
(2) medSask Drug News - Vol. 32, No. 3 Cough and Cold Medications in Pregnancy and Lactation Apr 2015

Jan. 12, 2017Is it okay for me to take Benadryl while breastfeeding? details
 

Response: Yes, this is considered safe in normal doses.
References: 1. Medications and Mother's Milk - T.Hale, H. Rowe 2014

Jan. 13, 2017Can I take Tylenol (acetaminophen) in 1st trimester? details
 

Response: Pregnant Women
Acetaminophen is considered to be safe for the short-term treatment of fever and pain during pregnancy; it is often the drug of first choice in pregnant women. Long term use or supratherapeutic doses may be associated with fetal liver toxicity. Observational studies have demonstrated potential associations between acetaminophen use during pregnancy and greater risk of developing asthma or behavioural problems in offspring, however firm conclusions cannot be made. Nevertheless, experts recommend acetaminophen as the drug of choice in pregnancy for short-term or intermittent use; and recommend against the routine use of any medication in pregnancy, including acetaminophen.
References: RxTx

Jan. 15, 2017"I have a small rash on my back since being in the hospital. The RN noted it could be from the epidural and said I could take a Benadryl. Can I do that while breastfeeding? I also have Reactine" details
 

Response: Yes, you can take antihistamines
-side effects that may be experienced if taking high doses for several days include drowsiness and CNS depression in the babe, and decrease lactation in the mom (though this was only seen when doses were very high and given by IV route). (1)
References: <1> LactMed

Jan. 16, 2017Will these meds be OK to take while breastfeeding? Tylenol, Ibuprofen, Ranitidine. details
 

Response: Yes, they will all be okay to take while breast feeding. (1)
References: 1. Drugs in Pregnancy and Lactation
2. Lexi-comp

Jan. 17, 2017Is Amoxicillin OK with breastfeeding? details
 

Response: Yes it is compatible.
References: Lactmed

Jan. 17, 2017Can my friend take Gravol Ginger? She is 9 weeks pregnant. details
 

Response: Listed as "possibly safe":
Population research from 1020 women who used ginger during pregnancy, including 466 in the first trimester, did not show any increased risk of congenital malformations, stillbirth, perinatal death, preterm birth, low birth weight, or low apgar scores associated with ginger use .(1)
Please note that the plain Gravol (dimenhydrinate) is considered safe in pregnancy and may be more effective. (2)
References: 1. Natural Medicines Comprehensvie Database
2. Briggs - Drugs in Pregnancy and Lactation

Jan. 17, 2017I am breastfeeding a 7 week old and feel very nauseated. Can I take a Gravol (dimenhydrinate)? details
 

Response: Small amounts are secreted in breastmilk (1) It can be taken for short periods of time. (2) Monitor infant for drowsiness or irritability. (1)
References: 1. Lexi - DimenhyDRINATE (Pregnancy and Lactation, In-Depth)
2. Schaefer

Jan. 18, 2017Can I take a dose of Tylenol #3 prescribed to me for migraines - I am nursing 18 month old twins. details
 

Response: In most mothers, codeine taken in moderation should be safe for a breastfed infant. Monitor for excessive sleepiness, poor feeding, grey skin color and if these symptoms occur let your doctor know right away.
Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral codeine to 4 days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Excessive sedation in the mother often correlates with excess sedation in the breastfed infant. Following these precautions can lower the risk of neonatal sedation. The American Academy of Pediatrics recommends that other agents are preferred over codeine during breastfeeding.(2)
References: 1) Medications and Mother's Milk - T.Hale, H. Rowe 2014
2)Lactmed

Jan. 18, 2017I had general anasthesia today to have a cyst removed I was wondering if I could breastfeed tonight? Baby is 18 months old. details
 

Response: On discussion she was told after the surgery to wait 24 hours before resuming breastfeeding. She was not sure what meds she took so I couldn't further comment on how long it may take before the meds would be out of her system but advised to follow the advice she was given earlier today as they were specific she wait a full 24 hours.
References: professional knowledge

Jan. 18, 2017Can I use A535 for back pain in pregnancy - I went to ER they said I was early labour but sent me home while labour progresses. They gave me morphine but it wore off and I have pain. details
 

Response: Suggested not to use A535 as limited info on safety in pregnancy. She said she would take 2 Estra Strength Tylenol and would also follow nursing suggestions for applying heat etc.
References: 1 - Lexicomp

Jan. 19, 2017Can I take ibuprofen while breastfeeding (baby is 37 weeks old)? details
 

Response: Yes.
References: (1) lactmed

Jan. 19, 2017Is ibuprofen safe to take during pregnancy (6 to 7 weeks) for a headache? details
 

Response: Recommend using acetaminophen rather than ibuprofen during pregnancy.
References: (1) briggs

Jan. 19, 2017I am 12 weeks pregnant and I have a cracked tooth. I'm going to dentist tomorrow. However, it is very painful and I would like to take something. What can I take and what dose? details
 

Response: Acetaminophen is the analgesic of choice in the first trimester.(1) You can take the dose on the label (caller has 500 mg tablets). Start with one tablet and if not quite enough within 30 minutes, take a 2nd. Thereafter, take 2 tablets q4-6 h. If one tablet is enough, continue that q4-6h.(2)
References: 1. CTC - Acute pain
2. Lexicomp

Jan. 19, 2017I was prescribed Clavulin (amoxicillin—clavulanic acid) today. Can I continue to breastfeed? details
 

Response: Amoxicillin and clavulanic acid is acceptable to use during breastfeeding. Limited information indicates that serious reactions in infants are very uncommon during the use of amoxicillin-clavulanic acid during nursing, with restlessness, diarrhea and rash occurring occasionally. If amoxicillin-clavulanic acid is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for these reactions during nursing.
References: (1) lactmed

Jan. 20, 2017My sister has shingles and is breastfeeding a 13 week old. She has a prescription for Valtrex. Can she keep breastfeeding? details
 

Response: Valtrex is considered compatible with breastfeeding. (1,2)
References: 1. Stockley's
2. Briggs

Jan. 21, 2017We have scabies in the family so are supposed to treat everyone. I am breastfeeding a 2 month old. Can I use the Kwellada-P and do I treat the baby? details
 

Response: Yes, it is considered compatible with breastfeeding and can be used to treat children 2 months of age and older.
References: 1. RxTx - CTC Scabies and Lice

Jan. 22, 2017My partner is 27 weeks pregnant and experiencing a lot of heart burn. Is it safe to take Tums? What else can she use? details
 

Response: Yes. Tums would be the best choice to start with. If those do not work, she could try using Ranitidine.
References: 1. Lexi-Comp/General Knowledge

Jan. 22, 2017Is it safe to take Benadryl or Reactine while pregnant? I have a severe itch that is driving me crazy. details
 

Response: Yes. Benadryl is considered the first choice and Reactine is considered an acceptable 2nd choice (less safety data vs benadryl). If the antihistamine does not work, I would recommend that you follow up with your doctor.
References: 1. PHARMACIST’S LETTER / PRESCRIBER’S LETTER November 2006 ~ Volume 22 ~ Number 221112

Jan. 23, 2017What is the best/safest med in pregnancy for anxiety. Episodes are once every couple of months; currently controlled. details
 

Response: Sertraline may be the drug of choice.
In umbilical testing they found one of the lowest ratios of serum concentrations with sertraline. (1) One of the newest studies by the CDC couldn't confirm any association between sertraline and birth defects. (10) If you are considering breatfeeding, sertraline has extensive data in that area as well. (12) Sertraline levels in the babies, after breastfeeding are often below the detectable limit. (12) All the babies mentioned in "Medications and Mother's Milk" said that the babies reached all developemental milestones.(12)
Longer answer:
In the CDC study, published the middle of 2015. They took into account new data, previously reported data, and information from the National Birth Defects Prevention Study. While they confirmed higher incidences of birth defects with some of the SSRI's like fluoxetine or paroxetine, the risk is still very low. The example they gave was with paroxetine exposure early in pregnancy and the development heart defects. The incidence in the general population of this defect is about 10 per 10,000 births, and while on paroxetine it rises to 24 per 10,000 births. (10) So with that very low risk of defects in mind; that is why people will tell you, that if you're stabilized on a medication while pregnant, you should just stay on the med. The risk to the baby from the med itself is really small, but the risk to the infant with a mother with untreated depression or anxiety also significant. Untreated depression or anxiety during pregnancy, can lead to suicide attempts,(6) high blood pressure, low birth weight babies and early labor. (13)
So if you end up switching medications and it doesn't work out, going back to escitalopram would be a viable option for you.
References: 1.Drugs during pregnancy and Lactation; treatment options and risk assessment. Edited by Christof Schaefer, Paul Peters, and Richard K. Miller. 2011.
2. Adrienne Einarson, RN. Antidepressant use during pregnancy. September 2013. http://www.motherisk.org/prof/updatesDetail.jsp?content_id=1062.
3. Adrienne Einarson RN and Gideon Koren MD. Counseling pregnant women who are treated with paroxetine. November 2005 - Special Supplement.
4. Lauren Chad, MD, Anna Pupco, MD, Pina Bozzo, Gideon Koren, MD FRCPC FACMT. Update on antidepressant use during breastfeeding. June 2013. http://www.motherisk.org/prof/updatesDetail.jsp?content_id=1000.
5. S. Kalra, A. Einarson RN, Gideon Koren MD, FRCPC. Taking antidepressants during late pregnancy - How should we advise women? August 2005. http://www.motherisk.org/women/updatesDetail.jsp?content_id=730.
6. Resham Ejaz, Tom Leibson, MD and Gideon Koren, MD FRCPC FACMT. Selective serotonin reuptake inhibitor discontinuation during pregnancy. December 2014. http://www.motherisk.org/prof/updatesDetail.jsp?content_id=1094.
7. Adrienne Einarson, RN. Paroxetine use in pregnancy and increased risk of heart defects - Evaluating the evidence. August 2010. http://www.motherisk.org/prof/updatesDetail.jsp?content_id=931.
8. ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. CARRIE ARMSTRONG
Am Fam Physician. 2008 Sep 15;78(6):772-778. http://www.aafp.org/afp/2008/0915/p772.html.
9. Anxiety and Depression Association of America. Pregnancy and Medication. https://www.adaa.org/living-with-anxiety/women/pregnancy-and-medication.
10. Key Findings—A Closer Look at the Link Between Specific SSRIs and Birth Defects. CDC. July 2015. https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/ssrisandbirthdefects.html
11. Specific SSRIs and birth defects: bayesian analysis to interpret new data in the context of previous reports. BMJ 2015;351:h3190.
12. Medications and Mother's Milk. 2014. Book.
13. Alicja Fishell. Depression and Anxiety in Pregnancy. June 2010. http://www.jptcp.com/articles/depression-and-anxiety-in-pregnancy.pdf.

Jan. 23, 2017I'm having a bit of an asthma flare. Is it safe to use salbutamol and budesonide nebs? I am 31 weeks pregnant. details
 

Response: Studies are reassuring regarding the rarity of adverse effects on human pregnancy outcomes with salbutamol and inhaled glucocorticoids (especially budesonide and fluticasone). (1)

Adverse events have been observed in some animal reproduction studies. Sallbutamol crosses the placenta. Congenital anomalies (cleft palate, limb defects) have rarely been reported following maternal use during pregnancy. Multiple medications were used in most cases, no specific pattern of defects has been reported, and no relationship to salbutamol has been established. The amount available systemically following inhalation is significantly less in comparison to oral doses.

Uncontrolled asthma is associated with adverse events on pregnancy (increased risk of perinatal mortality, preeclampsia, preterm birth, low birth weight infants). Salbutamol is the preferred short acting beta agonist when treatment for asthma is needed during pregnanc

Studies of pregnant women specifically using inhaled budesonide have not demonstrated an increased risk of congenital abnormalities. Uncontrolled asthma is associated with adverse events on pregnancy (increased risk of perinatal mortality, pre-eclampsia, preterm birth, low birth weight infants). Inhaled corticosteroids are recommended for the treatment of asthma during pregnancy; budesonide is preferred (1)
References: (1) UTD management of asthma during pregnancy
(2) lexicomp
(3) briggs

Jan. 23, 2017What is the safest antidepressant to take while breastfeeding? Baby is 5 months old. details
 

Response: Questioning revealed that caller used venlafaxine in the past with success. This was after trial of several other antidepressants (citalopram being the only one she could remember) that were ineffective. While the metabolite of venlafaxine may be excreted into the milk, accumulation is really only a concern with newborns/premature infants. Considering venlafaxine has been effective in the past, suggested to start with this one.
References: 1. Lactmed

Jan. 23, 2017Can I take gravol while breastfeeding my 10 month old? details
 

Response: Small, occasional doses of dimenhydrinate would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug.
References: (1) lactmed

Jan. 24, 2017Breastfeeding 20 week old infant - is it ok to take DM (dextromethorphan) cough syrup? details
 

Response: This should be OK for short term use. Make sure product doesn't contain alcohol. Use is best limited to 2-3 days max. No reports describing the use of dextromethorphan during human lactation or measuring the amount, if any, excreted into milk have been located. The relatively low molecular weight of dextromethorphan (about 271) suggests that passage into milk probably occurs. Many preparations containing dextromethorphan also contain ethanol. These products should be avoided during nursing. Preparations without ethanol, however, are probably safe to use during breastfeeding.
References: Lactmed
Briggs

Jan. 24, 2017I'm looking for an herbal tea that is safe to drink while pregnant. I have one with rooibos and one with hibiscus, rose hips and poppy seed. details
 

Response: Rooibus - insufficient info to determine if safe in pregnancy. (1,2)
Hibiscus - may have abortifacient effects - not recommended. (1)
Rose hips and poppy seed - Generally Recognised As Safe (1)
References: 1. Natural Medicines Comprehensive database
2. About Herbs, Botanicals & Other Products | Memorial Sloan Kettering Cancer Center

Jan. 24, 2017Is it ok to take Dilaudid (hydromorphone) and amoxicillin while breastfeeding? She forgot to tell the doctor. Baby is 20 months old and is only breast fed once a day at night. details
 

Response: Amoxicillin - yes
Dilaudid - no. It would be preferable to use Ibuprofen or Acetaminophen instead - doctor is treating a sore throat. Patient did not seem willing to withhold the Dilaudid, so suggested she hold off breastfeeding until she was done with it. Did not seem to want to do that either. Left the decision up to her after presenting the 2 options.


Limited data indicate that hydromorphone is excreted into breastmilk in small amounts. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of hydromorphone to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
References: Lactmed
Hale

Jan. 26, 2017Is it okay to take Depo-Provera while breastfeeding? details
 

Response: It's a category L4, or not recommended. The main reasoning for this is the potential for lowered milk production, and since the medication could not be quickly withdrawn, this would be a concern. However, if milk supply is not an issue and is well established, milk levels should not be impacted.

Safety to the infant looks excellent; one large study found no detectable levels of the hormone, or its metabolites, in the infant after repeating dosing.
References: 1. Hales Mother's Milk

Jan. 27, 2017Safety of venlafaxine while breastfeeding? Baby is 5 months old. details
 

Response: Venlafaxine is excreted into breast milk. Because of the relatively high infant dose in comparison with other antidepressants, recommend that close observation of the infant for short-term adverse effects (e.g., agitation, insomnia, poor feeding, or failure to thrive). Other antidepressants may be a better choice, such as sertraline - discuss with physician. (1,2)
References: 1. Briggs
2. Schaefer

Jan. 28, 2017Can I take Gravol for nausea if breastfeeding? details
 

Response: Yes. Gravol can enter the breastmilk, but it is generally considered compatible with breastfeeding. Monitor the infant for sedation.
References: 1. Micromedex

Jan. 28, 2017Is it safe to take gravol if I am 7 weeks pregnant? details
 

Response: Gravol is considered to be a category B medications. Studies have shown that the rate of malformation in mothers who used Gravol during pregnancy is equal to that of those who do not. Thus, you could use it over the weekend, but follow up with your physician on Monday as there are alternative medications available, such as Diclectin.
References: 1. Micromedex

Jan. 30, 2017I found out I was pregnant 3 weeks ago. My doctor took me off all my psychiatric medications, so I'm just on a few vitamins now. I've been very nauseated the past 3 days, and can't keep anything down. Is it withdrawal from my medications? details
 

Response: Meds stopped 3 weeks ago - nausea just appearing 3 days ago. Nausea due to withdrawal of quetiapine and clonazepam would occur within 7 days of discontinuation; suspect it may be nausea and vomiting of pregnancy instead.

She's taking Diclectin but not very helpful. Going to see her GP about it tomorrow.

Encouraged her to follow up with her psychiatrist. Sometimes we need to balance risks and benefits of continuing certain medications during pregnancy - should be assessed by her psychiatrist.
References: (1) RxTx
(2) Handbook of Psychotropic Drugs, 20th edition

Jan. 30, 2017Can my wife take Gravol? She's 16 weeks pregnant and has a stomach flu. She started vomiting at 5pm this evening. details
 

Response: Yes, Gravol is appropriate (1,2).
References: (1) RxTx
(2) drugdex

Jan. 30, 2017We have scabies and treated ourselves with Nix cream last night. My wife is breastfeeding a 1 month old. She stopped breastfeeding after the treatment last night. Could she resume breastfeeding this afternoon? details
 

Response: Yes. Nix cream is considered compatible with breastfeeding. (1,2)
References: 1. Briggs
2. RxTx - Lice and Scabies

Feb. 2, 2017What can I use for a cold (Headache/Fever/Sinus/Cough) while breastfeeding? Baby is 7 months old. details
 

Response: Avoid decongestants as these can reduce milk letdown. Nasal decongestants may still cause this problem, so use with caution.

Continue to use Advil or Tylenol for pain/fever, and consider gravol for sleep to help ignore the symptoms at night.
References: 1. Lexicomp
2. RxFiles
3. Pharmacist Letter

Feb. 2, 2017I'm currently breastfeeding, and I want to know if it's safe to take Picosalex for a colonoscopy tomorrow? details
 

Response: Sodium Picosulfate is not well absorbed, and is considered safe to use while breastfeeding. Magnesium Oxide and Citric Acid are safe while breastfeeding. You may use this product.

I would caution use only if you were sick/dehydrated as this could precipitate worse symptoms.
References: 1. Lexicomp
2. Hales

Feb. 2, 2017I'm 5 months pregnant, and want to know if I can take Combatrin? details
 

Response: Combantrin is poorly absorbed, and reached undetectable levels in the plasma when a single dose was given. It's category C, and considered safe in pregnanacy when used as a single dose.
References: 1. Lexicomp
2. Micromedex
3. Hales

Feb. 2, 2017I am 9 weeks pregnant and diabetic. I have a toothache, because my temporary filling fell out. What can I take for pain? details
 

Response: Advised her to try taking 2 tabs of acetaminophen 500mg in an hour, if it helps, then take another 2 x 500mg tabs in about 6 hrs and thereon. Maximum dose = 4000mg a day
There's a very likely chance that acetaminophen won't be enough so as nurse said, please see a doc/dentist within 24hrs.
References: 1. motherisk

Feb. 3, 2017I am 38 weeks pregnant. Can I take Advil for my headache? details
 

Response: Acetaminophen is the recommended pain reliever at this stage of your pregnancy.
Because they may cause premature closure of the ductus arteriosus, the use of NSAIDs late in pregnancy should be avoided. Product labeling states use of ibuaprofen should be avoided starting at 30 weeks gestation.(1,2)
References: 1)Briggs
2)RxTx

Feb. 4, 2017Is it safe to use Now Solutions Magnesium Spray if I am 8 weeks pregnant? I am having a lot of morning sickness and Diclectin is not working. The Sangsters worker said this could help. (No NPN or DIN number) details
 

Response: Given there is no NPN on this product we can not confirm this medication contains what the label states it contains. However, if it does contain what it states, there is only Magnesium and water in the product. Magnesium is considered safe during pregnancy when taken within the recommended daily limit (350mg/day). The label states that each 4 sprays contains 66mg of elemental magnesium, thus if all of this magnesium is absorbed you could use it 5 times per day. Please check and see how much magnesium is in your pre-natal vitamin before using the product. I would also recommend that you see your doctor on Monday for further assessment of your morning sickness.
References: 1. Natural Medicine Comprehensive Database
2. https://www.nowfoods.com/beauty-health/magnesium-topical-spray

Feb. 5, 2017I'm wondering what I can use for flu like symptoms while breastfeeding? details
 

Response: Most agents are okay to use, but decongestants will reduce milk letdown, so they're best avoided. She only had combination pills with decongestants, so she wanted to take one despite potential risks to help with symptoms this evening.
Agents she has on hand are:
Buckleys Complete - 2 mg chlorpheniramine maleate, 15 mg dextromethorpan hydrobromide and 30 mg pseudoephedrine hydrochloride, 500 mg acetaminophen.
Cepacol Lozenges - Benzocaine
Nyquil cold and flu multisymptom - Acetaminophen 325 mg, Dextromethorphan Hydrobromide 10 mg, Phenylephrine Hydrochloride 5 mg
Tylenol Cold and Flu - Pain reliever/Fever reducer: acetaminophen 500 mg, Cough suppressant: dextromethorphan, hydrobromide, 10 mg, Nasal decongestant: phenylephrine hydrochloride 5 mg, Antihistamine: chlorpheniramine maleate, 2mg
References: 1. Lexicomp
2. RxFiles
3. Hales

Feb. 6, 2017Is Beano OK while pregnant? (Has been taking it for 2 - 3 weeks BID) details
 

Response: Because of it's Mode Of Action it should be no concern. However, simethicone has more pregnancy info and is not absorbed so may be a better choice.
Beano® contains a natural food enzyme that helps prevent gas before it starts. It works with your body's digestion to break down the complex carbohydrates in gassy foods, like fresh vegetables, whole grain breads and beans, making them more digestible. Beano® enables you to enjoy your favorite healthy foods, whether at home, in a restaurant or at a friend's house, without worrying about gas. Beano® is not a drug.
How does beano® work?
Beano® contains an enzyme from a natural source that works with your body's digestion. It breaks down the complex carbohydrates found in gassy foods into simpler, easily digestible sugars before they reach the colon, preventing gas before it starts.
Medical Considerations
Can I take beano® if I'm pregnant or breast-feeding?
There is no information to indicate that beano® is unsafe for use during pregnancy or while breast-feeding. (1)
Alpha-D-galactosidase is effective in reducing symptoms of flatus and abdominal discomfort associated with the consumption of nonabsorbable carbohydrates(2)

Mechanism of Action
Natural food enzyme that breaks down complex sugars in gassy foods, making them more digestible and less gassy.(3)
References: 1)Beano.com
2)RxTx
3)Lexicomp

Feb. 7, 2017How long should I wait before breastfeeding after taking Fentanyl and Versed? details
 

Response: The doses found in breast milk are extremely low for both medications (0.05ng/mL after 50mcg Fentanyl, and 9ug/L after 15mg Midazolam). Therefore, it should be safe to breastfeed now, but you may pump and dump once if you're concerned.

No waiting period or discarding of milk is required before resuming breastfeeding after fentanyl is used for short procedures (e.g., for endoscopy).
Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of fentanyl to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.

The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. Two expert panels advocates waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing.[1][2] However, no waiting period or discarding of milk might be necessary before resuming breastfeeding after a single dose of midazolam in the mothers of infants over 2 months of age. After general anesthesia, breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse (2)
References: 1. Hales
2)Lactmed

Feb. 7, 2017Is it okay to take Baclofen when breastfeeding? details
 

Response: Symptoms were non specific, but she had an epidural when giving birth 11 days ago, so I had concerns about possible meningitis - Wasn't sure why she was prescribed baclofen for a headache in the first place.
I asked her to call RUH and see if they felt her symptoms merited her driving into the city tonight.
Baclofen is safe in lactation if used.
References: 1. Lexicomp
2. Hales
3. UpToDate

Feb. 8, 2017My 18 yr old daughter is 35 weeks pregnant and in the hospital. They wanted to give her one dose of morphine for pain is that ok when she is pregnant? details
 

Response: One dose of morphine should not be a problem to take when pregnant. If she was to take it chronically there would be potential risk to the baby.
References: Lexicomp - Briggs

Feb. 9, 2017Is it OK to use Myoflex? (Active Ingredient triethanolamine salicylate) details
 

Response:
Leg cramps are common in pregnant women. We suggest nonpharmacologic interventions such as calf stretching.
If a cramp occurs, calf stretches (toe raises), walking, or leg jiggling followed by leg elevation may be helpful. Other nonpharmacologic remedies include:
●A hot shower or warm tub bath
●Ice massage
●Regular exercise for conditioning, calf strengthening and stretching
●Increased hydration
●Use of long-countered shoes and other proper foot gear

Short term use on small areas is OK (3) but since this is an extensive area non-pharmacologic measures would be better. (3)
References: 1)Myoflex.ca
2)UTD - Musculoskeletal changes and pain during pregnancy and postpartum
3)Drugs During Pregnancy and lactation - Schaefer

Feb. 9, 2017Can I take 5-HTP? details
 

Response: PREGNANCY AND LACTATION: Insufficient reliable information available; avoid using. (1,2)
Do not use if pregnant/breast feeding or if you have scleroderma.(3)
References: 1)NMCD
2)Micromedex
3)LNHP database

Feb. 9, 2017Can I take a Gravol if breastfeeding? Baby is 3 months old. details
 

Response: Small, occasional doses should not be of concern. (1)
References: 1. LactMed

Feb. 10, 2017What can I take for a cough and cold? I was thinking of NeoCitran. I am 5 months pregnant. details
 

Response: Pseudoephedrine, in the lowest dose and shortest duration possible is considered the decongestant of choice. However it may be prudent to avoid its use in the first trimester of pregnancy.
Dextromethorphan is the preferred antitussive in both pregnancy and lactation. Consider lack of evidence of efficacy.
Acetaminophen is considered the analgesic/antipyretic of choice in both pregnancy and breastfeeding (1)
NeoCitran Fku products contain these ingredients so would be OK for occasional use.(2)
Cautioned on dosing of acetaminophen - don''t take added Tylenol with NeoCitran.
References: 1)medSask document - Cough and Cold Medications in Pregnancy and Lactation
2)NeoCitran.ca

Feb. 11, 2017Can I take Tylenol Complete Cold, Cough and Flu if breastfeeding? details
 

Response: Each TYLENOL® Complete Cold, Cough & Flu Daytime caplet contains:
Analgesic: acetaminophen (extra strength), 500 mg
Decongestant: pseudoephedrine hydrochloride, 30 mg
Expectorant: guaifenesin, 100 mg
Cough suppressant: dextromethorphan hydrobromide, 15 mg

Each TYLENOL® Complete Cold, Cough & Flu Nighttime caplet contains:
Analgesic: acetaminophen (extra strength), 500 mg
Decongestant: pseudoephedrine hydrochloride, 30 mg
Antihistamine: diphenhydramine hydrochloride, 25 mg (1)
Breastmilk production is not an issue. Occasional doses of this product (recommended the Daytime formula) would be fine. (2)
References: 1. www.tylenol.ca/products/cough-cold-flu/tylenol-complete-cold-cough-flu#ingredients
2. MedSask doc: Cough and Cold Medications in Pregnancy and Lactation

Feb. 13, 2017I have a vaginal yest infection. Is it safe to use Canesten (clotrimazole) topical products? details
 

Response: Yes. It is recommended to use a Canesten 7 Day treatment.
References: 1. Lexi-Comp

Feb. 13, 2017What can I take for my illness? 3 weeks post partum and breastfeeding My symptoms are: Nausea (some vomiting past 24h) / dizziness / headache / sweats No fever details
 

Response: - Undiagnosed illness

1. For the headache, acetaminophen is fine to take.

2. For the nausea, dimenhydrinate 50mg q4-6h can be taken. It does get into the breastmilk, so may cause some drowsiness / sedation in your baby. If he is much sleepier than usual, or not eating like he normally would, cease use of dimenhydrinate. It reaches it's highest levels in your breaskmilk in about 2 hours, so avoid breastfeeding around that time to minimize exposure.

3. If your illness (especially the vomiting) doesn't start improving in the next 24h, see a doctor.
References: 1. Hale

Feb. 14, 2017Can I take gravol while breastfeeding? details
 

Response: Small, occasional doses of dimenhydrinate would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug.
References: Lactmed

Feb. 14, 2017Can you tell me about the pregnancy safety information with venlafaxine? details
 

Response: 1. Most data shows very low risk of any safety issues, when it comes to malformations or other pregnancy issues. Venlafaxine is not guaranteed safe, but your low dose and starting it at 12 weeks helps minimize any risk. Also, the risk of untreated depression/anxiety of pregnancy is known (premature birth, low weight, poor adapation) and higher than the possible risk associated with the antidepressant.

2. The known safety issue is that use during the 3rd trimester can cause the baby, when born, to have some issues like agitation, restlessness, irritablity, poor feeding, jitteriness--this is usually mild and does not last longer than 2 weeks, and requires no management other than observation. If possible, stopping treatment in 3rd trimester is an option if depression/anxiety are well-controlled.
References: 1. UTD, Infants with antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
2. Briggs

Feb. 16, 2017My wife is on amoxi-clav for an infection and now the baby has diarrhea. Could it be from this antibiotic? details
 

Response: Summary of Use during Lactation:

Amoxicillin and clavulanic acid is acceptable to use during breastfeeding. Limited information indicates that serious reactions in infants are very uncommon during the use of amoxicillin-clavulanic acid during nursing, with restlessness, diarrhea and rash occurring occasionally. If amoxicillin-clavulanic acid is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for these reactions during nursing.

Discuss with the doctor - your wife may be able to stop taking the anitibiotic now. Make sure the baby is getting enough liquids - peeing OK and nursing well.
References: Lactmed

Feb. 17, 2017I am pregnant and feel anxious and depressed so my doctor told me to go on sertraline as he thought it was the safest but I feel agitated on it and have an upset stomach. Should I continue? details
 

Response: The Side Effects you are experiencing are common especialy initially but generally lessen with time. Sertraline has been used in pregnancy and appears to be safe:
Several reviews have found that in most studies, early pregnancy exposure to sertraline was not associated with major congenital abnormalities overall, nor with cardiovascular malformations in particular . Studies that found sertraline was not associated with birth defects. (1)
Your desire to go off should be dicussed with your doctor.
References: 1- Up to Date

Feb. 19, 2017I am in my first trimester and I an constipated. Can I use Colace? details
 

Response: Docusate sodium (Colace) can be used although there is not a lot of evidence for effectiveness. The short-term use of docusate for the treatment of constipation is generally considered safe during pregnancy. (1) Psyllium and Lactulose would be safe alternatives(2)
References: 1- Up to Date
2- Pharmacist Letter 221210

Feb. 21, 2017Is this Canesten Vaginal Cream ok in pregnancy? I am 5 months along. details
 

Response: Yes - no problem
References: Lexi

Feb. 21, 2017Are probiotics and biotin OK to take if breastfeeding? Baby is 10 months old. details
 

Response: Both should be fine at recommended dosing.(1)
Probiotics are sometimes given to infants so as long as you are not overdoing the dosing for yourself they should be fine. Watch for diarrhea in the baby and discontinue if that occurs.
References: NMCD

Feb. 22, 2017My sister is due on in 2 days and has a cold. Could she take Tylenol Sinus? details
 

Response: Each Extra Strength TYLENOL® Sinus Daytime light green tablet contains:

Pain reliever/Fever reducer: acetaminophen, 500 mg
Nasal decongestant: phenylephrine hydrochloride, 5 mg

Each Extra Strength TYLENOL® Sinus Nighttime dark green tablet contains:

Pain reliever/Fever reducer: acetaminophen, 500 mg
Nasal decongestant: phenylephrine hydrochloride, 5 mg
Antihistamine: chlorpheniramine maleate, 2mg (1)

Phenylephrine may cause reduction of uterine blood flow at therapeutic doses so best avoided near delivery.
She could take Tylenol and occasional doses of a deongestant nasal spray. (2) Saline nasal spray could safely be used.
References: 1. https://www.tylenol.ca/products/sinus/tylenol-sinus#ingredients
2. MedSask doc: Cough and Cold Medications in Pregnancy and Lactation

Feb. 23, 2017My wife is using a cream for her nipples - hpa-lanolin cream. It says it's safe to use while breastfeeding but I want to double check. Baby is 10 weeks old. details
 

Response: Yes, it should be fine.
References: (1) www.lansinoh.com

Feb. 23, 2017Can I take ranitidine for heartburn while pregnant (30 weeks)? Tums is not helping anymore. details
 

Response: Yes it's appropriate to try ranitidine as the next option (1)
References: (1) rxTx

Feb. 23, 2017I have a stomach bug, can I take Gravol while breastfeeding? details
 

Response: Small, occasional doses of dimenhydrinate would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug.
References: (1) lactmed

Feb. 24, 2017What antihistamine can I use? In the past I have used Reactine but I don't know if I can use it while breastfeeding. details
 

Response: Reactine is OK to use.
Summary of Use during Lactation:
Small occasional doses of cetirizine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The British Society for Allergy and Clinical Immunology recommends cetirizine at its lowest dose as a preferred choice if an antihistamine is required during breastfeeding.[1]
References: Lactmed

Feb. 24, 2017I found some Claritin in my purse. Is that OK to use while breastfeeding? Baby is 5.5 months old. details
 

Response: Yes - same information as Reactine for breastfeeding.
Summary of Use during Lactation:
Because of its lack of sedation and low milk levels, maternal use of loratadine would not be expected to cause any adverse effects in breastfed infants. Loratadine might have a negative effect on lactation, especially in combination with a sympathomimetic agent such as pseudoephedrine. The British Society for Allergy and Clinical Immunology recommends loratadine at its lowest dose as a preferred choice if an antihistamine is required during breastfeeding.[1]
References: Lactmed

Feb. 24, 2017How much Tylenol can I take if I am 10 weeks pregnant? details
 

Response: You can take a regular dose of Tylenol 325-1000mg every 4-6 hours (max 4gm in 24 hr)
References: 1. lexi-Comp

Feb. 24, 2017My doctor instructed me to take Advil for my severe headache, fever, body aches etc. I was taking Tylenol and it was not working. The Advil has helped, but I am wondering how much is safe to take if I am 8 weeks pregnant. details
 

Response: Some experts suggest Advil at any time during pregnancy or prior to conception places the baby at risk for malformations. Thus, if your fever and headache is now under control you may wish to consider going back to Tylenol. (Caller not willing to use Tylenol at this point) However, if you do decide to continue with Advil, you can take 400mg every 4-6 hours as needed (max 3200mg per day)
References: 1. Lexi-Comp
2. Pharmacist Letter

Feb. 25, 2017Is it safe to take Gravol and loperamide if I am breastfeeding? details
 

Response: Gravol - yes, it can enter the breastmilk and affect the supply, however, it is considered usually compatible with breastfeeding

Loperamide - yes, it can enter the breastmilk, but in small quantities. It is considered usually compatible with breastfeeding
References: 1. Pharmacist Letter April 2007 ~ Volume 23 ~ Number 230412

Feb. 25, 2017Is it safe to take Tylenol Cold + Sinus (acetaminophen, pseudoephedrine, chlorpheneriamine) if I am breastfeeding? Baby is 2 months old. details
 

Response: Yes.
Pseudoephedrine can enter the breast milk and possibly reduce the quantity milk in poorly established supplies. It has also been reported to cause irritability in 20% of infants. Chlorpheneramine can also enter the breastmilk, but is considered compatible. Be sure to monitor your baby for signs of irritability.
References: 1. Pharmacist Letter April 2007 ~ Volume 23 ~ Number 230412

Feb. 26, 2017Is there a cough medicine I can take for this cough? It is preventing me from sleeping. I am 22 weeks pregnant. details
 

Response: You can try dextromethorphan - although its effectiveness is questionable. It is in products like Benylin DM. Ask the pharmacist to help - you need a product that only has the DM in it. Lots of products have the DM in combination with other medications. (1)
References: 1. MedSask doc Cough and Cold Medications in Pregnancy and Lactation

Feb. 27, 2017Is sertraline safe to continue if I happen to get pregnant? details
 

Response: Several reviews have found that in most studies, early pregnancy exposure to sertraline was not associated with major congenital abnormalities overall, nor with cardiovascular malformations in particular. (1)

This is a discussion you should have with your physician - risk/benefit. Overall, sertraline is considered one of the preferred SSRIs in pregnancy (2)
References: (1) UTD
(2) RxFiles

Feb. 28, 2017Is it ok to take ibuprofen while breastfeeding? details
 

Response: Yes, not a problem.
References: Lexi

Feb. 28, 2017P.S. my prenatal vitamin has 200 mg DHA, and my prenatal "belly to baby" omega 3 supplement has 1200 mg omega 3, including 700 mg DHA. How much omega 3 mg is recommended? When I take my prenatal vitamin and omega supplements, that would be a total of 900 mg DHA... is that too high a dose? details
 

Response: The usual recommendation for pregnant women for DHA is between 200-600mg/daily, and there is likely no extra benefit to consuming additional DHA (1,4). DHA recommendation also suggests eating fish to satisfy omega intake over supplementation. (1,3) As for safety, the upper limit has not been established in pregnant women, but for general healthy adults, the upper limit is 3000mg per day. (2) Over 3000mg per day may precipitate an anticoagulant effect. (4)
References: 1. http://www.sciencedirect.com/science/article/pii/S0952327809001008
Pregnant women should consume 200–300 mg/day of DHA [30] and [31].
Pregnant and lactating women should achieve an average daily intake of least 200 mg of DHA.

2. http://www.dhaomega3.org/FAQ/Is-there-a-Tolerable-Upper-Limit-for-Omega-3-intake-in-adults
IS THERE A TOLERABLE UPPER LIMIT FOR OMEGA-3 INTAKE IN ADULTS? Print PDF
Average daily intakes of DHA/EPA (sum) in N.Am. And Japan approach 130 and 900 mg, respectively. The FDA (US) has considered that up to 3000 mg /day may be generally safe for healthy adults.

3. http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/omega3-eng.php

4. natural medicines

Mar. 1, 2017Can I use fake nails in pregnancy - is the glue safe? details
 

Response: The ingredient used in her nail clue was cyanoacrylate - I could not find pregnancy info on this ingredient. Theroetically, a topical product on the nail that is not applied to the skin should have very little to no aborption into the body if it only apllied on the nail. It is your choice if the benefit outweighs the risk.
References: 1. lexi
2. e-CPS
3. UpToDate

Mar. 1, 2017I was given one small dose of morphine yesterday at 5pm after my hand surgery. I was wondering if it would be ok to breastfeed now? I have pumped and disposed of milk at least 3 times since the surgery. details
 

Response: Yes, morphine is fairly short acting so it would be safe to breastfeed since it has been greater than 24 hours since your dose of morphine.
References: 1. Medications and mothers' Milk
2. Hale

Mar. 2, 2017I am breastfeeding my 19 month old twins. After a single dose of midazolam, diazepam or IV fentanyl for anesthesia during my colonoscopy, when can I resume breastfeeding? details
 

Response: After general anesthesia of single dose midazolam or fentanyl, a breast feeding mother may resume breastfeeding as soon as they have recovered from the anaesthetic to nurse. Some studies have shown that less than 1% of the maternal dose of these medications is found in breast milk. The drugs are unlikely to influence healthy term infants however if you are still concerned some professionals recommending waiting 4 hours after the dose before breast feeding or you may pump and dump the following feeding. In a study, a mom given 6 mg midazolam IV had undetectable midazolam in the breast milk after 4 hours. Waiting to feed or skipping the next feeding may be more important if receiving multiple anesthetic agents. (1) If there is transfer of the drugs in the breast milk the most common side effect would be sedation. (3)

Diazepam (Valium) may be appropriate for single dose anesthesia without waiting to resume breastfeeding, however it is a longer acting benzodiazepine. Diazepam’s half life is 42 hrs compared to midazolam’s half life of 2-5 hours. This means it will take longer for diazepam to clear to body compared to midazolam. (4)
References: 1. Lactmed
2. Briggs drugs in lactation (from lexicomp)
3. Medications in mothers milk
4. Drugs during pregnancy and lactation

Mar. 2, 2017I've been on Amoxicillin for 3.5 days now and my baby has had diarrhea all throughout, is that possible and should I stop? details
 

Response: *Diarrhea 3-4 episodes per day
*still eating / drinking normally; no signs dehydration
*5 week old baby exclusively breastfed

1. Amoxicillin is one of the preferred antibiotics in breastfeeding. Very low amounts get into the breastmilk, much less than what we would give an infant directly. Thus, it could be something else is causing your baby's diarrhea. (1)

2. However, given your mild case of mastitis that has completely resolved, you could safely stop the amox (it's also not indicated for mastitis) (2)

3. If the baby's diarrhea does not improve/resolve in 24-48h, assess for other causes/see doctor.
References: 1. Hale
2. UpToDate, mastitis

Mar. 5, 2017Can I take some acetaminophen 500mg if I am pregnant? details
 

Response: If you take regular doses (less than 4 gm/day), and not on a chronic, on-going basis, there should be no issue.
The use of acetaminophen in normal doses during pregnancy is not associated with an increased risk of miscarriage or still birth; (1)
References: 1. Lexi comp
2. Briggs

Mar. 5, 2017I am breast feeding and I think I am having a mild reaction to something. Can I take a Benadryl? details
 

Response: Small, occasional doses of diphenhydramine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives. (1) When treatment is needed in breast-feeding women, second generation antihistamines are preferred (2)
References: 1- LactMed
2- Lexi comp

Mar. 7, 2017What can I take for my cold, or possibly sinusitis, symptoms? I'm 8 weeks pregnant. details
 

Response: 1. First, given you've had these symptoms without improvement for 14 days, it would be worth seeing the doctor for consideration of an antibiotic.

2. For now, you can safely use acet 500mg QID PRN for your headache pain. You may also add something like benadryl which may help your runny nose, but mostly will help you sleep. Lastly, a saline rinse can help clear the excess mucous. A nasal spray decongestant can be used for 3-4 days if congestion becomes an issue.
References: 1. Pharmacist's Letter, Cough and Cold Medicine Use in Pregnancy
2. medSask, http://medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

Mar. 8, 2017Can I increase my dose of diclectin to accommodate my severe nausea? details
 

Response: *7-9 weeks pregnant
* Extreme nausea- has been vomitting for 2 and a half weeks. Last few days has not been able to keep any food down at all.
* Even fluids induce nausea

This kind of nausea requires medical attention via physician/hospital, as we will likely want to try alternative therapies if there is risk for malnutrition or dehydration. (1) Self-treating this degree of nausea and vomiting with possible dehydration by increasing the dose of diclectin would be insufficient. The maximum dose is 4 tablets per day as well, which you are already at.
References: 1. UpToDate, treatment of hyperemesis gravidarium
2. Diclectin product monograph

Mar. 9, 2017Can I use Canesten (Fluconazole 150mg capsule) for my yeast infection while breastfeeding? details
 

Response: 1. Yes--the amount of fluconazole that gets into the breastmilk is very minimal--less than the amount a new baby would be given directly if they needed treatment of an infection with fluconazole.
References: 1. Lactmed
2. Hale, Medication and Mother's Milk

Mar. 9, 2017Is it okay to use Castor oil topically during pregnancy? details
 

Response: Castor oil is contraindicated for use in pregnany when used orally as it can induce labor, or cause preterm delivery/spontaenous abortion. However, there is little data for topical use.

A 2002 study found that topical administration shows no change in metabolite epoxydicarboxylic acid. However, the authors caution that this does NOT mean it was not absorbed, and that further studies are needed.

Given the lack of clear benefit that castor oil has in hair growth, and the potential for harm, it's best to avoid use.
References: 1. Lexicomp
2. Hales
3. Transdermal Absorption of Castor Oil (Mein Et.al)
4. NMCD

Mar. 11, 2017Can I take Tylenol Cold & Sinus? details
 

Response: *7 weeks pregnant

No. The product contains an oral decongesant, which is not recommended in the first trimester. You could use nasal saline spray, tylenol, or decongestant nasal sprays for short-term use. (1)
References: 1. MedSask doc: Cough and Cold Medications in Pregnancy and Lactation
2. Briggs

Mar. 13, 2017Can I use halls, vicks vaporub, or echinacea in pregnancy? details
 

Response: - Cough candies with menthol and eucalyptus have unknown safety in pregnancy--it simply has not been formally studied. However, the consensus is that since they are very commonly used treatments in pregnancy, and no issues have come up, they likely are safe for short term use. Stick to around 4-5 candies per day.

- For echinacea, again, there is very limited data. One study of 112 women who used echinacea during the first trimester, between 250-1000mg per day for 7 days, found no issues. This is not enough to make definitive conclusions, however. The 250-1000mg dosage range refers to the "purpurea" content, not the crude content. Limit how long you use them for.
References: 1. https://www.ncbi.nlm.nih.gov/pubmed/11074744?dopt=Abstract
2. Briggs
3. NMCD
4. Medsask newsletter, http://medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

Mar. 14, 2017Can I take Benylin Extra Strength Mucus and Phlegm? details
 

Response: *8 months pregnant
*product contains guaifenesin

1. Guaifenesin has unproven efficacy, but it is likely safe in pregnancy, though no definitive data exists. I would recommend a humidifier, warm beverage with lemon or honey, and drinking plenty of water. It is not harmful for short-term use if you want to give it a try. (2)
References: 1. RxTx
2. MedSask doc - cough and cold medications in pregnancy and lactation
3. Briggs

Mar. 15, 2017My girlfirend is 4 months pregnant and she is taking Restoril, Ativan and Valium. She says she needs them but I think they may harm the baby. What can you tell me? details
 

Response: These medications may be related to some birth defects such as heart defects; but for the most part, they are considered quite safe in pregnancy as long as they are not abused. The greater the dosage and the longer the use, the more chance the baby may be affected. If she is using all three medications and at a high dose (caller says she takes 4 Restoril to sleep), she definitely could be endangering the baby. She should discuss her use with the Dr (or you should if she won't). There are safer medications for sleep/anxiety problems during pregnancy. (1,2,3)
References: 1. Briggs
2. Schaefer
3. UTD - Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy

Mar. 17, 2017I was at the hospital today for a consultation with the lactation consultant. I was told to take Fenugreek 3 capsules TID and Blessed Thistle. My fenugreek container shows 2 caps BID. How should I be taking this medication? details
 

Response: Fenugreek should be taken as a max of 1725mg three times daily. Thus, since your capsules are 610mg each, you should only take 2 capsules twice daily. Blessed thistle is not recommended for use during lactation due to a lack of safety and efficacy data.
References: 1. Natural Medicines Comprehensive Database

Mar. 18, 2017We are considering adopting a child from a mother who has been on levetiracetam, clonazepam, escitalopram, clonidine and buprenorphine at some point in her pregnancy. Can you tell me the risks of these medications when used in pregnancy? details
 

Response: 1)Buprenorphine - neonatal abstinence syndrome if used close to delivery, slightly increased risk of neural tube defects (baseline is 4-6/10 000)

2) Clonazepam - increased risk of malformations with this class of medication, but not confirmed with clonazepam specifically. Increased risk of premature birth, increased risk of low birth weight, and neonatal abstinence syndrome if used close to delivery.

3) Escitalopram - increased complications at birth, if used close to delivery, due to a "disontinuation syndrome" (irritable, feeding issues, low blood glucose, seizures).

4) Clonidine - no human studies. Animal studies do not show an increased risk of malformation when given 3x the max dose

5) Keppra - likely safe in humans, but some risk of abnoralities noted in animal studies.

**discussed risk vs. benefit, baseline risks etc.
References: 1. Lexi-Comp
2. Micromedex
3. Briggs

Mar. 20, 2017What can I take for allergies? I have used Reactine in the past. details
 

Response: Maternal use of cetirizine has not been associated with an increased risk of major malformations. Cetirizine may be used for the treatment of rhinitis and urticaria during pregnancy.
References: 1. Lexicomp

Mar. 21, 2017Is it ok to take reactine while Im breastfeeding my 9 month old? details
 

Response: Small occasional doses of cetirizine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The British Society for Allergy and Clinical Immunology recommends cetirizine at its lowest dose as a preferred choice if an antihistamine is required during breastfeeding.[1]
References: Lactmed

Mar. 21, 2017Is it ok to take amoxicillin when pregnant? details
 

Response: *4 months pregnant.

1. Yes, amoxicillin is considered safe and the antibiotic of choice for many infections during pregnancy. Repeated use in the 1st trimester may pose a slight increased risk of an oral cleft (increases from 1-2 per 1000 to 2-3 per 1000), but there is conflicting information about this risk.
References: 1. LEXI
2. Briggs

Mar. 22, 2017Is there something I can take for a head cold while breastfeeding? details
 

Response: Her main sx were nasal congestion and sore throat. Suggested using advil for sore throat. Since on domperidone and issues with milk supply, suggested using dristan or otrivin nasal spray twice daily for up to 3 days as this would have the least amount of systemic absorption and lowest effect on milk supply.
References: Medications and Mothers' Milk

Mar. 23, 2017My newborn son has diarrhea and I'm wondering if my PEG may have caused this? details
 

Response: Very unlikely, as PEG is poorly absorbed, and would likely not cause these symptoms in a breastfed toddler. I would be more concerned that your recent antibiotic course may have caused these symptoms. Continue the probiotic he is on, and do not withhold breastfeeding as adequate hydration is a must. Please see your doctor tomorrow if the diarrhea does not improve, or if blood develops in the stool/sunken eyes/no tears when crying/slow to response or irregularly irritable.
References: 1. CDC guidelines for the treatment of acute diarrhea
2. Lexicomp

Mar. 23, 2017I'm having nausea and vomitting, can I take something? details
 

Response: *Nurse assessment done: not dehydrated or serious, no other symptoms
*Baby is 6 months old

1. Yes, you can safely take gravol (dimenhydrinate) 50mg every 4-6h for a few days. It does get into the breast milk is very low levels, and may cause your baby some drowsiness, but even this is quite rare. It reaches its highest levels in your breast milk in 2 hours, so avoid breastfeeding at that point to reduce infant exposure.
References: 1. Hale, Medication in Mothers Milk

Mar. 25, 2017I saw a nurse practitioner today for my sore tooth. She told me to take tylenol and to contact you to see if oragel is safe during pregnany. I am currently at the hospital as the pain is unbearable. details
 

Response: There is not enough reliable information available regarding the safety of Benzocaine (oragel) in pregnany to recommend its use. Benzocain may cross the placenta and possibly cause adverse effects to the baby, but this is largely unstudied.. I would suggest avoiding this product and use Tylenol 1gm Q6H as needed. If the tylenol does not help you will need to see a physician for something stronger (ie morphine). You should also see a dentist to investigate why the tooth is causing so much pain, and fix the root of the problem.
References: 1. Lexi-Comp
2. Micromedex

Mar. 27, 2017Can I breastfeed my 18 month old while on diclofenac 5% gel? details
 

Response: Yes, it is fine to breastfeed while on topical diclofenac, based on the fact that oral diclofenac is known to be compatible with breastfeeding.

It is not known if topical diclofenac is excreted in breast milk; however, when administered orally, low concentrations of diclofenac can be found in breast milk. According to the manufacturer, the decision to breastfeed during therapy should take into account the risk of exposure to the infant and the benefits of treatment to the mother. Product labeling for diclofenac solution specifically notes it should not be used by nursing women. (1)

One reviewer classified diclofenac as one of several low-risk alternatives, because of its short adult serum half-life (1.1 hours) and toxicity profile compared with other similar agents, if an NSAID was required while nursing Ref. Other reviewers have also stated that diclofenac can be safely used during breastfeeding Ref. Another NSAID in the same subclass as diclofenac is classified as compatible with breastfeeding by the American Academy of Pediatrics.(2)
References: 1)Lexicomp
2)Briggs
3)Lactmed

Mar. 27, 2017Is this OK to this muscle relaxant (Ibuprofen and methocarbanol) while breastfeeding? details
 

Response: Breast-feeding Summary:

No reports describing the use of methocarbamol during human lactation have been located. Because newborns have been directly treated for tetanus with methocarbamol, any amount excreted in milk is probably clinically insignificant.
T1/2 is 1 - 2 hours so if you want to limit the baby's exposure you could try timing the dosing by delaying nursing by 4 hours after administration of the motrin platinum.
References: Briggs
Lexicomp

Mar. 29, 2017I am breastfeeding a 3 month old and have a cold, what can I use? details
 

Response: *Main symptom = stuffy nose

1. For congestion, a nasal spray decongestant like Oxy/xylometazoline is best/safest (1). Use only for 3 days max to avoid rebound congestion. If needed, a stronger pill decongestant like pseudoephedrine can be used short-term, for a few days, since your milk supply is well-established.

2. If sore throat, acet / ibuprofen are safe.
References: 1. http://medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

Mar. 29, 2017My Dr thinks I may have MS and has recommended I take 4000 IU of Vitamin D/day. I am breastfeeding my 1 year old son. Is this dosage safe to take if breastfeeding or will it have negative effects on my son? details
 

Response: The levels of Vitamin D that are transferred in breastmilk are much lower than those achieved in Mom. (1,2,3) Even when large doses of vitamin D (4000 i.u. daily) were given to the mother for 3 months, no ill effects were observed in the infant (1)
References: 1. Schaefer
2. Briggs
3. Hale

Mar. 29, 2017I'm 24 weeks pregnant and have sinusitis, and am wondering: - Is amoxicillin ok during pregnancy and any drug interactions with my meds? - Can I use Nasonex? I'm getting conflicting information - Can I use baby orajel for inflammed gums? details
 

Response: 1. Amoxicillin is safe, and no drug interactions with your medications (amitriptyline and synthroid).

2. Intranasal corticosteroids are generally considered safe in pregnancy. They are barely absorbed into the system, and even less would be passed to your baby. They may be of concern if being used throughout pregnancy, such as for severe allergic symptoms, but just short-term use over 1-2 weeks is fine. They do not have to be used in sinusitis, but they do improve symptoms and possibly speed resolution.

3. Baby orajel is possibly safe, but it does get absorbed and passed to the baby when used on mucous membranes like in the mouth. The only data available is that 47 moms who used benzocaine in the 1st trimester (short-term, few days only), and 238 moms who used it at any point in their pregnancy, did not have any issues. It is suggested to control the pain with known safe measures, however, and to avoid benzocaine containing products.
References: 1. Briggs, Pregnancy and Lactation
2. Friedman JM. Teratogen update: anesthetic agents. Teratology 1988;37:69-77.[PubMed 3279563]

Mar. 29, 2017I am 35 weeks pregnant and will be off work after today. I have diarrhea and have been using rehydration but it isn't resolving. I have to go to work today and can't go with this diarrhea. Is there anything I can take to get through the day? details
 

Response: Imodium can be used if rehydration is not adequate. The smallest dose for the shortest duration is recommended. (1,2) If diarrhea continues tomorrow, I would see physician.
References: 1. Briggs
2. Schaefer