Consumer Pregnancy and Lactation Question Collection

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

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

Response: Yes - no problem
References: Lexi

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, 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, 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, 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, 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, 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, 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 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. 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. 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, 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

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

Response: Yes, not a problem.
References: Lexi

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'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. 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. If there is transfer of the drugs in the breast milk the most common side effect would be sedation.

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.
References: 1. Lactmed
2. Briggs drugs in lactation (from lexicomp)
3. Medications in mothers milk
4. Drugs during pregnancy and lactation

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

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

For now, you can safely use acetaminophen 500mg QID PRN for your headache pain. You may also add something like diphenhydramine 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 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. 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. 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 it OK to use 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, 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 the mother. (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 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 recommend seeing your doctor.
References: 1. Briggs
2. Schaefer

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, acetaminophen or ibuprofen is safe.
References: 1. http://medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

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

Response: 1. Amoxicillin is safe, and there are 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]

Apr. 3, 2017Patient is 7 weeks pregnant and hurt her back while moving boxes. What is safe to take for pain in pregnancy? (Patient has not yet tried anything). details
 

Response: For pain in pregnancy, non-pharmaceutical options such as ice and rest are first line. If analgesics are needed, acetaminiophen is the first option and safe to take in pregnancy.
Advise NOT to take NSAIDs such asibuprofen, naproxen, Aspirin, in 1st or 3rd trimester.
Instructed that if acetaminophen is not effective, the next step would be to schedule an appointmentt with MD.
Caller asked if chiropractic is possible in pregnancy. Yes - pregnant women indeed can see a chiropracter butcheck with chiropractor to make sure they have appropriate training in pregnant population.
References: 1. RxFiles 11th Edition. Pain and Fever in Pregnancy. Updated March 2017.

Apr. 3, 2017My doctor has mentioned to me in the past that if I were to get pregnant she'd have to switch some of my medications. I found out today that I'm pregnant (~ 4 weeks). Do I need to stop taking my meds? I have an appointment with my doctor in 4 days. details
 

Response: Recommend that she continue with her medications until she can see her doctor on Friday. Neither is contraindicated during pregnancy. Hypertension and anxiety are also not beneficial during pregnancy, so discouraged stopping medications abruptly and encouraged her to start taking a prenatal vitamin that contains folate.

Human pregnancy experience with escitalopram is very limited. The animal data suggest that the risk to an embryo-fetus is low. Two large case-control studies did find increased risks for some birth defects, but the absolute risk appears to be small. However, selective serotonin reuptake inhibitor (SSRI) antidepressants have been associated with several developmental toxicities, including spontaneous abortions, low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral syndrome (withdrawal), possibly sustained abnormal neurobehavior beyond the neonatal period, respiratory distress, and persistent pulmonary hypertension of the newborn (PPHN).

Propranolol has been used during pregnancy for maternal and fetal indications. The drug is apparently not a teratogen, but fetal and neonatal toxicity may occur. Some β-blockers, including propranolol, may cause intrauterine growth restriction (IUGR) and reduced placental weight, especially those lacking intrinsic sympathomimetic activity (ISA) (partial agonist). Treatment beginning early in the 2nd trimester results in the greatest weight reductions, whereas treatment restricted to the 3rd trimester primarily affects only placental weight. Propranolol does not possess ISA. However, IUGR and reduced placental weight may potentially occur with all agents within this class. Although growth restriction is a serious concern, the benefits of maternal therapy with β-blockers, in some cases, might outweigh the risks to the fetus and must be judged on a case-by-case basis. Newborn infants of women consuming the drug near delivery should be closely observed during the first 24-48 hours after birth for bradycardia, hypoglycemia, and other symptoms of β-blockade. Long-term effects of in utero exposure to β-blockers have not been studied but warrant evaluation.
References: (1) briggs
(2) lexicomp
(3) rxfiles

Apr. 4, 2017What can I take for my diarrhea while breastfeeding? details
 

Response: *Mom's diarrhea was quite severe (~4x per day) but staying hydrated and keeping food down. No other symptoms such as fever present.

Loperamide is safe to use while breastfeeding. Recommend the standard regimen; 2 tablets stat, then one tab per loose bowel movement to a maximum of 8 tabs per day. No harm to infant noted due to extremely low amounts in breastmilk. Watch for drowsiness in yourself / infant. If this persists without improvement over 48h, see your doctor
References: 1. Hale
2. CTMA, diarrhea

Apr. 4, 2017I am still somewhat blocked in my nasal passages, especially at night, but feeling much better. Nasal discharge is very occasional, but can be somewhat yellow still. Today is day 7. So probably best to do ten days, as I am not totally cleared up, correct? If at ten days, I am not 100%, should I do the full fourteen days or wait it out to see if it continues to clear fully? I also read that bacterial sinus infections can cause harmful toxins for the baby in pregnancy. I had a cold for 7 days , and then a sinus infection for 10 days before antibiotics... I was hoping it was viral and would get better with home treatment. Now I'm sorry I waited so long. Is there any research or evidence indicating that a bacterial sinus infection could actually be harmful to a developing baby? details
 

Response: If the infection is still not cleared up then continue for 10 days. If after 10 days, you are not 100% then I would suggest getting reassessed.
Duration of antibiotic therapy recommended by the Infectious Diseases Society of America and in Canadian guidelines range from five to ten days for acute bacterial sinusitis (1)
Penicilllins (amoxicillin included) are the antiobiotics of choice in pregnancy.(2)
Amoxicillin crosses the placenta but is generally considered to pose no significant teratogenic risk. (3)
Bacterial sinus infections are not known to cause problems in pregnancy. Unless the infection severely restricts breathing, especially for longer periods such as while sleeping, there should be no harm to the foetus.
Snoring alone is not associated with fetal risk. In general, apnea and hypopnea are uncommon in pregnancy because of the beneficial effect of progesterone. Nighttime oxygen deficiency might adversely affect the fetus and poor fetal growth has been documented in patients with this condition. (4)
References: 1) CPL - Professional Resource, Antibiotic Therapy: When Are Shorter Courses Better? Pharmacist’s Letter/Prescriber’s Letter. November 2016.
2) Drugs During Pregnancy and Lactation - Schaefer
3) RxTx
4)http://emedicine.medscape.com/article/303852-overview#a8

Apr. 5, 2017Asked about symptoms - fever, cough? Productive or non productive? details
 

Response: Acetaminophen: Acetaminophen is routinely used during all stages of pregnancy for pain relief and to lower elevated body temperature. The drug crosses the placenta. In therapeutic doses, it is apparently safe for short-term use.

Dextromethorphan: The available human data on the reproductive effects of dextromethorphan do not demonstrate a major teratogenic risk.

Phenylephrine: NOT ok. Phenylephrine is a sympathomimetic used in emergency situations to treat hypotension and to alleviate allergic symptoms of the eye and ear. Uterine vessels are normally maximally dilated and they have only α-adrenergic receptors. Use of the predominantly α-adrenergic stimulant, phenylephrine, could cause constriction of these vessels and reduce uterine blood flow, thereby producing fetal hypoxia (bradycardia). Phenylephrine may also interact with oxytocics or ergot derivatives to produce severe persistent maternal hypertension (1). Rupture of a cerebral vessel is possible. If a pressor agent is indicated, other drugs such as ephedrine should be considered. Sympathomimetic amines are teratogenic in some animal species, but human teratogenicity has not been suspected.

Chlorpheniramine:Use of antihistamines, including chlorpheniramine, is low risk in gestation.

Non-pharmaceutical options: increase hydration, increasing humidity, warm compresses on the face
Since there is no fever, no pain, and no cough, I would suggest local topical saline nasal spray like Salinex.
If you really need an decongestant, you can use Dristan nasal spray (oxymetazoline). Last resort: pseudoephedrine 30 mg in the am for shortest duration is Ok. Take in the morning because it can cause stimulation.
References: 1) Briggs drugs in pregnancy and lactation
Acetaminophen is routinely used during all stages of pregnancy for pain relief and to lower elevated body temperature. The drug crosses the placenta (1). In therapeutic doses, it is apparently safe for short-term use.

2. lexicomp
Adverse fetal or neonatal effects have not been observed following normal maternal doses of oxymetazoline during the third trimester of pregnancy. Adverse events have been noted in case reports following large doses or extended use. Decongestants are not the preferred agents for the treatment of rhinitis during pregnancy. Short-term (<3 days) use of intranasal oxymetazoline may be beneficial to some patients although its safety during pregnancy has not been studied (Wallace 2008).

. Decongestants are not the preferred agents for the treatment of rhinitis during pregnancy. Oral phenylephrine should be avoided during the first trimester of pregnancy; short-term use (<3 days) of intranasal phenylephrine may be beneficial to some patients although its safety during pregnancy has not been studied.

(3) med sask website

Apr. 6, 2017I am having a stomach flu but am in my second trimester. Can I try Dimenhydrinate? details
 

Response: Non-pharmaceutical options are first line. Caller seemed quite ill and was strongly recommended to go see a physician. Counselled to use non-pharmaceutical options first and if that does not work she can take tacetaminophen for headache. Counselled to not take ibuprofen.
(1)
Dimenhydrinate is compatible with pregnancy and can be used at lowest effective dose for shortest period possible.
(1,2)
References: 1. Kosar L, Nausea and Vomiting in Pregnancy. RxFiles drug comparison charts. 11th ed. Saskatoon, SK: Saskatoon Health Region. [updated March 2017; accessed 06 April 2017]. Available from: www.RxFiles.ca
2. Motherisk- Dimenhydrinate. [Accessed April 6th 2017] Available at http://www.medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

Apr. 6, 2017I am 12 weeks pregnant. What can I take for headache? I have Tylenol Complete that contains 500 mg tylenol and 60 mg caffeine can I take this? details
 

Response: Non-pharmaceutical measures are first line (rest, ice on head, etc).
First-line drug therapy is acetaminophen on its own at the lowest effective dose.
Caffeine is safe to take in pregnancy as long as you do not exceed 300 mg.
Recommended to take acetaminophen on its own first and then if that didn't help take the Tylenol product with caffeine in 4-6 hours.
(1)
References: 1. Kosar L. Management of Pain and Fever in Pregnancy. RxFiles drug comparison charts. 11th ed. Saskatoon, SK: Saskatoon Health Region. [updated Mar 2017; accessed 06 April 2017]. Available from: www.RxFiles.ca

Apr. 7, 2017Is it okay to use Tylenol while breastfeeding? details
 

Response: Yes, no concerns.
References: 1. Hales

Apr. 11, 2017Is cephalexin OK if I'm breastfeeding? I looked it up on the internet and it said it is dangerous. details
 

Response: Cephalexin compatible with breastfeeding. It may rarely disrupt GI flora in the infant and cause diarrhea and gastrointestinal distress.
References: Lexi
Lactmed

Apr. 12, 2017Is there anything I can take for head cold in pregnancy? details
 

Response: I suggested tylenol 500mg up to 4 times daily for headache and sinus pain and suggested if she had to use anything for nasal congestion to only use a topical spray such as Otrivin or Dristan for no longer than 3 days duration. (less systemic absorption than using an oral decongestant)
References: on call references - pregnancy cough and cold

Apr. 12, 2017Caller is 11 weeks pregnant. What can she safely take for head cold and cough? Is Gravol OK? details
 

Response: For the cough - DM would be acceptable.
Avoid decongestants like phenyephrine and pseudoephedrine. A saline nasal spray is fine or Dristan and similar sprays for a short time and only if needed would be OK.
Lozenges or hard candies for throat are OK.
Avoid echinacea.(1)
Gravol is OK if needed.(1)
References: 1. medSask - Cough and Cold in Pregnancy document

Apr. 13, 2017I'm on ceftriaxone IV for a few more days, is breasfeeding ok? details
 

Response: Yes, no issues. Very low amounts in breastmilk, poorly absorbed from GI, and often used in neonates directly.
References: 1. Hale

Apr. 15, 2017I am 35 weeks pregnant and I wonder if I can take some Tylenol as I feel flu/feverish details
 

Response: Yes acetaminophen is safe to take in pregnancy in normal doses. (1)
References: 1= lexi comp

Apr. 15, 2017I am 6 weeks pregnant and I wonder if I can take Claritin (loratadine). details
 

Response:
Maternal use of loratadine has not been associated with an increased risk of major malformations. Loratadine may be used for the treatment of allergic rhinitis and urticaria during pregnancy (1)
References: 1- lexi comp

Apr. 16, 2017I am 6 weeks pregnant and my allergies are terrible. I have some Chlortripolon and some Reactine. Which one can I take? details
 

Response: Chlortriplon has the been considered first line (1). The ACOG (The American College of Obstetricians and Gynecologists) does not recommend Reactine during the 1st trimester. (1)
References: 1- Pharmacists Letter 221112

Apr. 17, 2017Can I take Benylin extra strength all-in-one cold and flu if breastfeeding? Baby is 17 months old. details
 

Response: Given the age ot the child and the ingredients, it is fine for short term use. (2)
Ingredients:

DM Cough Suppressant:
Dextromethorphan Hydrobromide

D Decongestant:
Pseudoephedrine Hydrochloride

E Expectorant:
Guaifenesin

A Analgesic:
Acetaminophen (Extra Strength)
References: 1. www.benylin.ca/extra-strength/all-in-one-cold-and-flu-day-night-caplets
2. MedSask doc: Cough and Cold Medications in Pregnancy and Lactation

Apr. 19, 2017Onset of nausea/diarrhea. She was wondering if ok to use both diclectin and ranitidine in pregnancy as she was prescribed both but rarely took either and didn't take together. details
 

Response: Her symptoms she felt were related not to pregnancy but either a stomach virus or food poisoning. She had what felt like reflux which is why she wanted to try ranitidine and also thought she would try a diclectin for nausea tonight. I told her both are considered safe in pregnancy and did not interact with each other.
She was aware of signs of dehydration and knew to go to ER if symptoms were present as this had happened to her once before.
References: lexi

Apr. 21, 2017I had gallbladder surgery yesterday. I had morphine before lunch and Tylenol #3 just after. Can I breastfeed my 3 month old now? details
 

Response: Yes. Most, if not all, would be out of your system by now.
References: 1. Lexi

Apr. 22, 2017I am 30 weeks pregnant and was prescribed Mometasone nasal spray for my sinus congestion. I started it yesterday and have developed a nose bleed. Is this safe for me to be taking during pregnancy? details
 

Response: Yes. Corticosteroids are considered the drug of choice for treating rhinitis/congestion during pregnancy.When using the nasal spray be sure to aim towards the outside of your nose (away from the septum), as this will help reduce the chance of further nose bleeds. If the nose bleeds continue you should follow up with your physician for a possible alternative therapy.
References: 1. Lexi-Comp

Apr. 24, 2017I've been taking metronidazole for a few days and it's awful. My stomach is in knots all the time, and then today I vomited blood (one episode, very small amount of blood). The nurse told me to stop taking it until I can see my doctor tomorrow, but will the infection clear up on just the cream? details
 

Response: There may be an opportunity to take oral clindamycin, or try a lower dose of metronidazole. Topical clindamycin alone is often used in nonpregnant women, and has been shown to be as effective as oral. Her doctor will need to decide on the appropriate treatment plan.
Treatment of trichomoniasis with oral metronidazole is recommended for all patients except asymptomatic pregnant women. Treat sexual partner(s) irrespective of symptoms or test results. There are no effective alternative topical or systemic treatments available for those patients who cannot use metronidazole (e.g., metronidazole hypersensitivity). In such situations, particularly if symptoms are persistent and severe, a supervised intravenous metronidazole desensitization protocol over a few hours may be the only effective treatment option.
Symptomatic BV infection — All women with symptomatic BV should be treated to relieve bothersome symptoms. Oral treatment is effective and has not been associated with adverse fetal or obstetrical effects. The therapeutic options include:

●Metronidazole 500 mg orally twice daily for seven days

●Metronidazole 250 mg orally three times daily for seven days

●Clindamycin 300 mg orally twice daily for seven days

Some clinicians avoid use of metronidazole in the first trimester because it crosses the placenta, and thus has a potential for teratogenicity. However, meta-analysis has not found any relationship between metronidazole exposure during the first trimester of pregnancy and birth defects, and the CDC no longer discourages the use of metronidazole in the first trimester. An additional concern is that the drug is mutagenic in bacteria and carcinogenic in mice, but there is no evidence of harm in humans.

As mentioned above, topical therapy is as effective as oral therapy in the treatment of nonpregnant women with BV. In contrast, some experts avoid topical therapy in pregnant women because they believe oral treatment is more effective against potential subclinical upper genital tract infection.
References: (1) rxtx
(2) utd

Apr. 24, 2017My daughter is not listening to her psychiatrist when it comes to her medications. He stopped her Seroquel when she got pregnant, but she's been taking it on her own anyway. Now she's run out, and is having lots of symptoms such as nausea, muscle stiffness, diarrhea, paranoia, and sweats (mild, but persistent for the past 3 days). I think she's going through withdrawal. I'm worried about the baby. details
 

Response: Summary of seroquel in pregnancy:

Although no structural malformations attributable to quetiapine or other agents in this subclass have been reported, the number of exposures is too low to fully assess the embryo-fetal risk. In addition, there is a risk of extrapyramidal and/or withdrawal symptoms in the newborn if the drug is used in the 3rd trimester. Nevertheless, quetiapine is indicated for severe debilitating mental disease and the benefits to the mother appear to outweigh the potential embryo-fetal risks. Because of the limited human pregnancy experience with atypical antipsychotics, the American College of Obstetricians and Gynecologists does not recommend the routine use of these agents in pregnancy, but a risk-benefit assessment may indicate that such use is appropriate. However, the benefits to the mother appear to outweigh the unknown risk to the embryo-fetus. A 1996 review on the management of psychiatric illness concluded that patients with histories of chronic psychosis or severe bipolar illness represent a high-risk group (for both the mother and the fetus) and should be maintained on pharmacologic therapy before and during pregnancy. Folic acid 4 mg/day has been recommended for women taking atypical antipsychotics because they may have a higher risk of neural tube defects due to inadequate folate intake and obesity. A 2010 review of antipsychotic use in pregnancy concluded that most studies reported no adverse effects, including congenital anomalies in the offspring of mothers who had taken quetiapine during pregnancy.
Going from 400mg to none could very well cause some adverse symptoms. Asked if she should go to ER tonight - based on severity of symptoms, and no signs of fetal distress (no bleeding, no cramping, can feel baby moving still) - no need for ER visit tonight. She should see her psychiatrist ASAP though to discuss treatment options and he should be informed that she was back on seroquel.
References: (1) Briggs
(2) RxFiles

Apr. 25, 2017I have some Toradol here and I am breastfeeding - is it ok? details
 

Response: Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or antiinflammatory agent in nursing mothers. She can also use acetaminophen if she wishes, but avoid the ketorolac.

______________________


Ketorolac is excreted into breast milk. Ten women, 2-6 days postpartum, were given oral ketorolac, 10 mg four times daily for 2 days. Their infants were not allowed to breastfeed during the study. Four of the women had milk concentrations of the drug below the detection limit of the assay (<5 ng/mL) and were excluded from analysis. In the remaining six women, the mean milk:plasma ratios 2 hours after doses 1, 3, 5, and 7 ranged from 0.016 to 0.027, corresponding to mean milk concentrations ranging from 5.2 to 7.9 ng/mL. Based on a milk production of 400-1000 mL/day, the investigators estimated that the maximum amount of drug available to a nursing infant would range from 3.16 to 7.9 mcg/day (Note: The cited reference indicated 3.16-7.9 mg/day, but this appears to be an error), equivalent to 0.16%-0.40% of the mother’s dose on a weight-adjusted basis. These amounts were considered clinically insignificant.

The FDA has placed a “Black Box” warning on ketorolac, stating that drug is contraindicated during breastfeeding because of the potential adverse effects of prostaglandin inhibiting drugs on neonates

Summary of Use during Lactation:

Limited data indicate that milk levels of ketorolac are low with the usual oral dosage, but milk levels have not been measured after higher injectable dosages. Use caution when using ketorolac in nursing mothers, especially with the injectable drug. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
References: Lactmed
Briggs

Apr. 25, 2017Jeannine from healthline asked what to tell the caller - she had an IUD put in on Friday (5 days ago) and today she has a positive pregnancy test. Healthline is asking whether I can tell her it is ok or should she contact doctor/hospital? details
 

Response: I told Jeannine who told the patient that she should seek medical attention. The test may not be accurate and should be confirmed. She will need to see doctor asap.

PREGNANCY — The risk of pregnancy is highest in the first year after IUD insertion. Malposition of the IUD is a risk factor.
If a woman becomes pregnant with an IUD in place, we first determine whether the pregnancy is intrauterine or extrauterine.

Women who conceive an intrauterine pregnancy with an IUD in place have a greater risk of adverse pregnancy outcomes compared with the general obstetrical population. Risks include miscarriage, septic abortion, chorioamnionitis, and preterm delivery. Among women who conceive with an IUD in situ, the miscarriage rate is approximately 50 percent, a rate more than two-fold higher than that of women who have the IUD removed.

Although the risk of adverse events is highest when the IUD is left in place, women who have the IUD removed still have an increased risk of adverse events throughout pregnancy, including preterm delivery, compared with women who conceived without an IUD. There does not appear to be an increased risk of birth defects in pregnancies conceived and carried with an IUD in situ, although there are insufficient data to draw definitive conclusions about the effect of levonorgestrel exposure on the fetus.
References: UpToDate -Intrauterine contraception: Management of side effects and complications

Apr. 25, 2017Can I take Advil for my toothache? details
 

Response: No. PREGNANCY RECOMMENDATION: Human Data Suggest Risk in 1st and 3rd Trimesters. Constriction of the ductus arteriosus in utero is a pharmacologic consequence arising from the use of prostaglandin synthesis inhibitors during pregnancy. Persistent pulmonary hypertension of the newborn may occur if these agents are used in the 3rd trimester close to delivery. These drugs also have been shown to inhibit labor and prolong pregnancy, both in humans and in animals. Women attempting to conceive should not use any prostaglandin synthesis inhibitor, including ibuprofen, because of the findings in a variety of animal models that indicate these agents block blastocyst implantation. Moreover, as noted below, nonsteroidal anti-inflammatory drugs (NSAIDs) also have been associated with spontaneous abortion (SAB) and with cardiac defects, oral clefts, and gastroschisis. The risk for these defects, however, appears to be small.

Recommended she take acetaminophen instead and see her dentist/doctor if pain worsens.
References: Briggs

Apr. 27, 2017Can I take/use these while breastfeeding? details
 

Response: Clarithromycin -OK
Cetirizine - OK when used at a low dose and for short periods after lactation is well established
Topical hydrocortisone1% cream -OK
References: 1)Lactmed
2)Briggs

Apr. 28, 2017My wife has been taking Benadryl (as recommended by her doctor) and since starting that our 5 day old daughter is very drowsy. Could this be related to the Benadryl? What should we do? details
 

Response: Benadryl can enter the breastmilk and cause irritability and drowsiness in the infant. I would recommend that your wife discontinues the Benadryl. She could use Loratadine if she needs an antihistamine, as this should not have a sedative effect on the baby. If the baby remains drowsy, I would rcommend that you take her to see a physician for evaluation to rule out other causes (health line nurse assessed infant and determined that she was fine).
References: 1. Micromedex
2. Pharmacist Letter (on call references)

Apr. 29, 2017Is it safe to take ENO if I am breastfeeding? details
 

Response: Unfortunately, I am unable to determine if the herbal products (Svarjiksara and Nimbukamlam) in this medication are safe in breastfeeding. They are not listed on our Natural Medicines database. The manufacturer states to consult a physician prior to use in breastfeeding. I would recommend that you try Tums, as this is considered safe in breastfeeding.
References: 1. ENO website
2. Natural Medicine Comprehensive Database (subscription expired??)

May. 2, 2017I just found out a couple of days ago that I'm about 2-3 weeks pregnant. I'm currently taking amitriptyline and Cymbalta (duloxetine) for treatment of migraines and fibromyalgia pain. I take 5mg of the amitriptyline once a day and 60mg of Cymbalta per day. I have read some mixed information regarding the use of these drugs during pregnancy. I am feeling a bit concerned about taking them at this time but know that I can't just stop them. I am wondering first of all, are these safe to take? And if it is best for me to get off of them (which I'm completely willing to do) how do I wean myself off of them? details
 

Response: Amitriptyline is a medication that’s been around for a long time. I has been well-studied in pregnancy and most studies show that it is not associated with any birth defects.
Cymbalta (duloxetine) is a fairly new medication. Small studies do not point to it causing any birth defects but most of the information given comes from other medications in it’s class.

The biggest concern with both amitriptyline and duloxetine is the possibility of pregnancy complications and adaptation syndrome in the infant.
There is a small chance that both may cause spontaneous abortion (not confirmed) and post-partum hemorrhage.
Amitriptyline has been associated with an increase in blood pressure and eclampsia and increases risk of constipation which can be a concern, particularly in later pregnancy.

Both medications may cause “adaptation syndrome” in the newborn. Symptoms include restlessness, rigidity, jitteriness, feeding difficulty, respiratory distress, and frequent startle reactions The signs begin in the first days of life and continue in the typical infant for less than 2 weeks, and for a month in very rare cases.

No negative effects on long-term development of the child have been found. (1,2,3)

This may sound ominous, but both medications are considered quite safe in pregnancy – especially amitriptyline. Your dose of amitriptyline is very small, so chances of any negative effects from it are low. Remember that Mom’s health is also very important in pregnancy. If discontinuing these medications decreases your health or causes you stress, that will also affect the baby. This must be taken into account.

If you decide to discontinue these medications, they must be tapered to avoid or minimize any discontinuation syndrome effects (which may include: cramping, diarrhea, nausea, sweating, hot or cold flashes, headache, dizziness, flu-like symptoms, fatigue, anxiety, restlessness, trouble sleeping, vivid dreams, tremors, muscle aches, confusion, pounding heart (palpitations), unusual movements, mood changes). The recommendation is to reduce the dose by 25% every week (i.e. week 1-75%, week 2-50%, week 3-25%) and this can be extended or decreased (10% dose reductions) if needed. If intolerable withdrawal symptoms occur (usually 1-3 days after a dose change), go back to the previously tolerated dose until symptoms resolve and plan for a more gradual taper. Dose reduction may need to slow down as one gets to smaller doses (i.e. 25% of the original dose). Overall, the rate of discontinuation needs to be controlled by the person taking the medication. (4)
References: 1. Drugs During Pregnancy and Lactation, Schaefer, C editor 3rd ed
2. Drugs In Pregnancy and Lactation, A Reference Guide to Fetal and Neonatal Risk Online
3. UpToDate: Risks of antidepressants during pregnancy: Drugs other than selective serotonin reuptake inhibitors
4. MedStopper Plan http://medstopper.com/

May. 6, 2017Is it safe to take Claritin if I am breastfeeding? details
 

Response: Yes. Some experts consider it to be the antihistamine of choice for use during breastfeeding.
References: 1. Pharmacis Letter (on call reference)

May. 7, 2017My child is 11 months old, and I'm wondering if I should breastfeed if I'm starting Clomiphene? details
 

Response: Clomiphene is L4 per Hales 'Medications and Mother's Milk'. It is likely best to avoid, as there is no data for use while breastfeeding, and this medication may diminish lactation.
References: 1. Hales

May. 9, 2017Can I use this product for my acne while breastfeeding? details
 

Response: *Nothing labelled as an active ingredient

1. The only one that may be of a concern is the salicyclic acid when used in high concentrations, long-term (1,2). The product you have is <2% (exact unknown, but higher than 2% requires labelling (3)). There's no specific data, but it is known that it's absorbed into your system and possibly into breastmilk (though unlikely), which the infant could then be exposed to. It's very likely safe to use, but caution is recommended (2).

Glycolic acid 3%

Some concern with prolonged use of salicylic acid. 5% had 25% systemic absorption.
References: 1. NMCD
2. Hale, Medsmilk.com
3. http://www.healthyenvironmentforkids.ca/sites/healthyenvironmentforkids.ca/files/cpche-resources/hotlist_2007_liste_critique_eng.pdf
4. https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~EeHrfm:1
*http://www.infantrisk.com/content/over-counter-treatments-skin-problems
*http://www.motherisk.org/prof/updatesDetail.jsp?content_id=946

May. 13, 2017I am breast feeding a one week old baby and I think I have a UTI. Can I use Cranberry pills if I am breast feeding? details
 

Response: No data exist on the excretion of any components of cranberry into breastmilk or on the safety and efficacy of cranberry in nursing mothers or infants.[1](2)
I agree with the healthline nurse and suggest you go to minor emergency clinic tomorrow.
References: 1- Natural medicines
2- Lactmed

May. 14, 2017I am 5 days post- Caesarean section and I still have some nausea and I am also breast feeding. I will be seeing the doctor tomorrow but I wonder if I can take a Gravol (dimenhydrinate) tablet tonight? details
 

Response: Yes: 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. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. (1)
References: 1- Lactmed

May. 14, 2017I have been having issues with nausea and the Diclectin does not appear to be working. I went to Emergency today and they put me on IV with saline and dexamethasone. I got home and started to read sbout the dexamethasone and it is advised not to use in pregnancy. details
 

Response: Glucocorticoid use in pregnancy may increase the risk of cleft palate in offspring, but the absolute risk is likely low. There is no convincing evidence that glucocorticoids cause fetal adrenal insufficiency and is often used in later terms to promote lung growth. (1)
A recent prospective, controlled study followed 311 women who used various corticosteroids during the first trimester. Both corticosteroid-exposed women and controls had malformation rates within the expected baseline risk for the general population. The authors also recalculated a cumulative risk from seven controlled studies, including their own study, and found no significant increase in risk of major anomalies. (2)
References: 1- Drugs during pregnancy and lactation -Schaefer
2- Mother Risk

May. 16, 2017I took one dose of this last night and another this morning - now my baby has runny green poop. Is this normal? details
 

Response: Clavulin is compatible in breast feeding but may cause diarrhea in the infant. Advised to contact doctor in the morning for further counsel. She may need a probiotic or a change in antibiotic.
Green Poop - baby may:
•Be getting too much watery milk from the start of the feed, and not enough of the richer milk that comes later. This may upset his tummy and cause him to cry a lot. Altering your breastfeeding technique should remedy this.
•Be sensitive to medication that you're taking, such as antibiotics or iron supplements, or to medication that he's taking.
•Be sensitive to something you’ve eaten. As well as having green poop, your baby may also have eczema or a rash. See your GP if this is the case.
•Have an infection, especially if he also has diarrhea.
References: https://www.babycentre.co.uk/x543050/why-are-my-breastfed-babys-poos-often-green
Lactmed

May. 16, 2017I have an ear infection and am taking clarithromycin. I breastfeed my 2 year old son for naps and before bed. Would there be any problems? details
 

Response: No. Levels of clarithromycin are low in the breastmilk and this drug would be given directly to a child of this age if needed. (1)
References: 1. LactMed

May. 17, 2017I am trying to get pregnant and am considering switching from citalopram to duloxetine. Is it safe in pregnancy? details
 

Response: There is limited human evidence of safety of duloxetine in pregnancy; however, of what is available, it appears to be similar to that of venlafaxine.(1) Due to the greater available data for venlafaxine, it was suggested to perhaps consider it, but that if duloxetine is chosen there is no reason to believe there will be greater harm.(1)
References: 1. Briggs

May. 17, 2017How do I stop the domperidone now that my lactation is well-established? details
 

Response: 1. Domperidone can be stopped relatively quickly, just so long you continually re-assess your milk supply. Given you're doing so well now, you could drop down to two tabs TID (9 per day down to 6 per day) for 3-4 days. If no problems, drop down to 1 tab TID for 3-4 days. Hold this for a week, then d/c entirely if no issues. If supply ever drops, return to the previous effective dose and taper down more slowly.
References: 1. http://www.bfmed.org/Resources/Download.aspx?filename=Protocol_9.pdf
2. http://www.bcwomens.ca/Professional-Resources-site/Documents/CW500_2007_Sept_IncreasingYourMilkSupply.pdf

May. 18, 2017I have a cold and am wondering if I can take Benylin since I'm breastfeeding my 3 month old? details
 

Response: The product the caller has on hand contains per capsule:
Acetaminophen 500 mg, dextromethorphan 15 mg, guaifenesin 100 mg, and pseudoephedrine 30 mg.(1)
The only potential problem with these ingredients is that decongestants, in higher doses, may disrupt milk supply.(2) Confirmed with caller that milk supply is well-established so if she were to take one capsule no more than 4 times per day, she should be okay. Suggested if she needs more for the sore throat, headache and back ache she can take an additional acetaminophen 325 mg or 500 mg along with each dose (one capsule) of Benylin.
References: 1. DPD
2. http://medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

May. 18, 2017I'm having severe heart burn causing vomiting. What can I safely take at 8 months pregnant? details
 

Response: *started today

1. If this continues for more than 24h, see your doctor immediately.

2. In the mean time, Ranitidine is a safe choice and you can buy it over the counter. You could take a dose of omeprazole tonight if you have no other options, but make sure you get this checked out by tomorrow if not feeling better.
References: 1. Lexicomp
2. Briggs

May. 18, 2017Can I use Canesten Vaginal Cream when pregnant? details
 

Response: Yes. (1,2)
References: 1. Briggs
2. Schaefer

May. 23, 2017Just used Canesten Vaginal tablets for a yeast infection and I'm breastfeeding - is that ok? details
 

Response: Yes - it's fine. No problem.
References: Briggs

May. 25, 2017I hurt my knee last week and was told to take ibuprofen for the inflammation. I just found out I'm pregnant (~6weeks). Is Advil OK? details
 

Response: There may be a small risk in the first trimester, so switch to acetaminophen for pain relief. Although it's not an anti-inflammatory it may give you some pain relief and is considered safer in pregnancy.
Because NSAIDs cause premature closure of the ductus arteriosus, prescribing information for ibuprofen specifically states use should be avoided starting at 30-weeks gestation.
Use of NSAIDs can be considered for the treatment of mild rheumatoid arthritis flares in pregnant women; however, use should be minimized or avoided early and late in pregnancy (1)
References: 1)Briggs
2)RxTx

May. 25, 2017I've been on clonazepam since before I was pregnant, and the whole time I've been breastfeeding. Last night my son stopped breathing. I rubbed his chest and he started again. The doctor is worried about him getting clonazepam through my milk. He told me to only give him milk after the clonazepam is out of my system. How long after my dose is it safe to pump/nurse him? details
 

Response: No plans to quit clonazepam.Other medications didn't work.
Since clonazepam has such a long half life, there wouldn't be a time period where it's out of her system prior to the next dose

Suggested she use formula- says she tried once and her baby spit it up. Discussed trying other types of formula or different brand and she said she isn't going to waste money on more formula.

Recommended she go back to her doctor to discuss a shorter acting benzodiazepine.
References: (1) Lexicomp
(2) Briggs
(3) Lactmed

May. 26, 2017What analgesic is safe while breastfeeding? What dose? details
 

Response: She has Extra Strength Tylenol (500mg acetaminophen).
You can take 2 x 500mg acetaminophen every 6 hours.
Summary of Use during Lactation:
Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare
References: Lactmed

May. 28, 2017"I am constipated. Only had 1 small hard bowel movement on Friday. Can't remember before that. Can I take my boyfriend's prescription laxative?" HPI: does not usually get constipated details
 

Response: Followed/recommended the RxFiles algorithm for pregnancy - 1) mobility and hydration, 2) Metamucil, 3) lactulose, and then 4) senna
Caller states she tried mobility and fluid (but not fibre intake) so may go directly to the Metamucil
References: <1> RxFiles (http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-Laxatives.pdf)

May. 29, 2017I started amoxicillin today for an ear infection (1 dose taken so far). I took a pregnancy test today and it was positive. Is it OK to continue with the amoxicillin? details
 

Response: First day of last period would estimate 5-6 weeks pregnant.

Penicillins are generally considered low risk at any stage of pregnancy. This assessment may have to be modified for the aminopenicillins (ampicillin and amoxicillin) because there is some evidence that exposure to these two antibiotics during organogenesis is associated with oral clefts. However, even if the association is causal, the absolute risk is very low.
(1)
Suggested she check in with her physician tomorrow - make him aware of her pregnancy to see if he wants to continue with amoxicillin or change treatment.
References: (1) Briggs
(2) UTD
(3) RxFiles

May. 30, 2017I took a Sudafed last night - I won't take it again. Can I use Benadryl? details
 

Response: You can take Benadryl today - it may cause drowsiness, but is OK in pregnancy. (1, 2)
Avoid the Sudafed and try a saline nasal rinse if needed.
References: 1)Briggs
2)Drugs During Pregnancy and Lactation - Schaefer

Jun. 7, 2017How long before trying to get pregnant should I stop Crestor? details
 

Response: Stopping crestor within a week of pregnancy would guarantee it is out of your system prior to conception.

Onset of action: Within 1 week; maximal at 4 weeks
Half-life elimination: 19 hours (1) ~4 days to eliminate.
Although there is no clear evidence that stains cause malformations, they are still contraindicated in pregnancy.

Limited evidence from animal and human studies indicates that statins should not be taken during pregnancy. If a patient is inadvertently exposed during pregnancy, however, termination does not appear to be medically indicated.

The limited human data suggest that statins are not major human teratogens. Thus, if women are inadvertently exposed to statins before recognition of pregnancy, they can be reassured that their fetuses do not appear to be at increased risk. Nonetheless, it seems reasonable to follow the current recommendation of discontinuing the medication immediately upon recognition of pregnancy or before conception if pregnancy is planned.
Animal studies show conflicting results, but in the reports in which an excess of congenital anomalies was reported in the statin-treated rodents, excessive doses were used compared with the regimens we commonly prescribe to human subjects.
References: 1)Lexicomp - Briggs
2)UTD - Statins: Actions, side effects, and administration
3) Use of lipid-lowering agents (statins) during pregnancy. Hosokawa A, Bar-Oz B, Ito S . Can Fam Physician. 2003;49:747.
4)Motherisk - http://www.cfp.ca/content/cfp/49/6/747.full.pdf
5)Expert Rev Cardiovasc Ther. 2012 Mar;10(3):363-78. doi: 10.1586/erc.11.196. Statin use during pregnancy: a systematic review and meta-analysis.
Kusters DM1
6)Journal of Clinical Lipidology
Volume 10, Issue 5, September–October 2016, Pages 1081–1090. The risks of statin use in pregnancy: A systematic review. Dean G. Karalis,
7)http://www.bmj.com/content/350/bmj.h1484.long. Statins in Pregnancy

Jun. 8, 2017Can I use ginger at 8 weeks pregnancy for nausea and vomiting? details
 

Response: Ginger does not appear to be teratogenic and is generally considered safe during pregnancy.
No interaction between diclectin and ginger - may take ginger anytime in relation to diclectin dose.
References: (1) RxTx
(2) lexicomp

Jun. 10, 2017When can breastfeeding resume after taking Plan B (emergency contraception)? details
 

Response: After use of levonorgestrel as a postcoital contraceptive, nursing can resume 3 to 4 hours after the dose (or after each dose if the two-dose method is used). Postcoital levonorgestrel appears to have no long-term adverse effects on breastfeeding.
References: 1- Toxinet

Jun. 12, 2017Can I take Tylenol #3 while breastfeeding (new born, 2 day old)? details
 

Response: Not recommended: Maternal use of codeine during breastfeeding can cause infant drowsiness, central nervous system depression and even death, with pharmacogenetics possibly playing a role. 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.

Also not recommended to take someone else's prescription medications.

Suggested she try Tylenol, Advil or naproxen rather than Tylenol #3s
References: (1) lactmed
(2) briggs

Jun. 12, 2017Is it ok to take sertraline while breastfeeding a 3 month old infant? details
 

Response: Yes; it is the safest and most recommended antidepressant for breastfeeding since it only gets into the breastmilk in very low levels, and no serious issues have been reported thus far. At worst, the baby may experience extra drowsiness initially. If this is impacting feeding and activity, the sertraline may need to be changed or stopped, but this is very unlikely aat your dose of 25mg.
References: 1. Hale, medication in mothers' milk online

Jun. 13, 2017Is Monurol (fosfomycin) ok to take while 34 weeks pregnant? details
 

Response: Yes, it appears to be very safe to take at any point in pregnancy.
References: Lexi
Briggs

Jun. 13, 2017Is Reactine OK to take while breastfeeding a 4 month old? details
 

Response: Claritin (L1) is recommended over Reactine (L2)
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.
Counselled to get the single ingredient product not in combination with a decongestant.
References: Lactmed
Medications and Mothers' Milk - Hale

Jun. 14, 2017Is rizatriptan safe to take while breastfeeding a 4 1/2 month old? details
 

Response: Since there isn't a lot of human information on rizatriptan, you could try sumatriptan which has more information and is OK with breastfeeding.

Rizatriptan:
Summary of Use during Lactation:
No published experience exists with rizatriptan during breastfeeding. If rizatriptan is required by the mother, it is not a reason to discontinue breastfeeding; however, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
Briggs Breast-feeding Recommendation:
No Human Data—Probably Compatible

In adults, the mean oral bioavailability of sumatriptan is 14%-15%, suggesting that absorption from the gastrointestinal tract is inhibited. Thus, although the oral absorption in infants may be markedly different from adults, the amount of sumatriptan reaching the systemic circulation of a breastfeeding infant is probably negligible. Discarding the milk for 8 hours after a dose, an interval during which about 88% of the amount excreted into milk can be recovered, would reduce even more the small amounts present in milk. The American Academy of Pediatrics classifies sumatriptan as compatible with breastfeeding.
References: 1)Lactmed
2)Briggs

Jun. 14, 2017I just took one of these: Tylenol Cold Complete plus Mucous Relief. Analgesic: acetaminophen, 250 mg; Decongestant: pseudoephedrine hydrochloride, 30 mg; Expectorant: guaifenesin, 100 mg; Cough suppressant: dextromethorphan hydrobromide, 10 mg (3). Is it OK while breastfeeding a 3 month old? details
 

Response: Suggested waiting at least 3-4 hours before feeding again, and if possible and use Tylenol or Advil rather than a multi-ingredient product.
Summary of Use during Lactation:
Neither the excretion of dextromethorphan or guaifenesin in milk nor its effect on breastfed infants have been studied. It is unlikely that with usual maternal doses amounts in breastmilk would harm the nursing infant, especially in infants over 2 months of age. It is best to avoid the use of products with a high alcohol content while nursing.
Summary of Use during Lactation:
Although the small amounts of pseudoephedrine in breastmilk are unlikely to harm the nursing infant, it may cause irritability occasionally. A single dose of pseudoephedrine decreases milk production acutely and repeated use seems to interfere with lactation. Mothers with newborns whose lactation is not yet well established or in mothers who are having difficulties producing sufficient milk should not receive pseudoephedrine.
References: 1)Lactmed
2)medSask document on cough and cold prducts in pregnancy and lactation
3)https://www.tylenol.ca/products/cough-cold-flu/tylenol-complete-cold-cough-flu-plus-mucus-relief-liquid-gels#ingredients

Jun. 14, 2017Can I take Combantrin (pyrantel pamoate) at 37 weeks pregnancy? details
 

Response: Pregnancy Recommendation:
No Human Data—Animal Data Suggest Low Risk
Animal reproductive studies have not resulted in any teratogenic effects, but pyrantel has not been studied in the pregnant patient. It should not be used in pregnant women, unless, in the judgment of the physician, it is deemed essential for the welfare of the patient.
At 37 weeks there should be no teratogenic risk.
Correct dose for you is 8 tablets (69kg and over)
References: 1)Briggs
2)RxTx

Jun. 14, 2017I threw up my ondansetron 4mg in about 10-15 minutes after taking it. Pill was not in vomit. Should I redose or not? (18 weeks pregnant) details
 

Response: You likely absorbed some of the medication, but not all of it, within 15minutes. If you are still feeling nausea within 30 minutes, which is when the pill should be working, then you can safely take another one. The allowed dose for ondansetron in pregnancy is up to 8mg every 12 hours, so even if you did absorb the full 4mg from the first pill, you're still within the suggested dosing if you take another.
References: 1. Lexi
2. Briggs

Jun. 16, 2017How early in a pregnancy can you get Rhogam? She is possibly 3-4 weeks pregnant. details
 

Response: My suggestion is to call your doctor and see when/if she will give the RhoGAM.
There is first trimester dosing, but your doctor may want to confirm pregnancy with a blood test.
All Rh(D)-negative pregnant women should undergo an antibody screen at the first prenatal visit. If the initial screen is negative, a routine repeat screen at 28 weeks of gestation is optional.
If WinRho®SDF is administered early in the pregnancy, it is recommended that WinRho®SDF be administered at 12 week intervals in order to maintain adequate levels of passively acquired anti-Rh.
Within 72 hours of complication - 300ug
WinRho SDF: IV, IM: 300 mcg immediately following a threatened abortion occurring any time during pregnancy.
References: 1)Lexicomp
2)UTD - Management of pregnancy complicated by Rhesus (D) alloimmunization
3)DPD - WinRHO monograph

Jun. 17, 2017I had an allergic reaction so I took Benadryl 25mg. Is this safe if I am breastfeeding an 11 month old infant? details
 

Response: Benadryl can enter the breastmilk, but not in high enough concentrations to affect the infant (when taking the usual dose). In high doses and with prolonged use, adverse effects have been seen in the infant such as irritability, drowsiness etc. If you needed to take one more dose this evening, it would likely be fine. Tomorrow, you may consider switching to Loratidine, as many experts consider this to be the antihistamine of choice for use during lactation.
References: 1. PHARMACIST’S LETTER / PRESCRIBER’S LETTER April 2007 ~ Volume 23 ~ Number 230412

Jun. 19, 2017Can I breastfeed my 2 year old when I get home from the hospital as I was given Dilaudid and Gravol IV in the hospital? details
 

Response: Maternal Levels. One old study that used a biologic assay system reported that after a 100 mg intramuscular dose of diphenhydramine in four women, drug levels in milk were undetectable in two and 42 and 100 mcg/L in two others at one hour after the dose. Five hours after the dose, milk levels were undetectable in two women and 20 and 100 mcg/L in two others. No studies using modern assay methods have been reported.
Small but unreported levels of diphenhydramine are thought to be secreted into breastmilk but you are not continuing to take it and the baby is not exclusively breast fed so it is probably compatible.

In adults, hydromorphone has an oral bioavailability of 62% and is metabolized to inactive metabolites. While not commonly used in infants, an appropriate dose for this age group is 10 mcg/kg parenterally or 30 mcg/kg orally every 4 hours as needed.

If a woman was given 4 mg dilaudid every 6 hours her infant would ingest about 0.002mg/kg/day or 2.2 mcg of the 4mg taken by the mother. This is significantly less than the clinical oral dose recommended fo infants and children with pain so you getting about 5mg in the hospital 9 hours ago would not impact your 2 year old.
References: 1. lactmed
2. Medications and Mothers Milk 2014 T.Hale et.al.

Jun. 23, 2017Is it safe to take Tylenol #3 and gabapentin if I just found out I am pregnant? details
 

Response: Gabapentin - there is not enough clinical experience with gabapentin in pregnancy to confirm its safety. The manufacturer recommend avoiding its use in pregnancy. I would recommend that you talk to your doctor about your pain control options during pregnancy. He/She may advise you to taper off of the gabapentin, depending on the risks and benefits.

Tylenol #3 - In general, use of narcotic analgesics during pregnancy is associated with fetal adverse effects which include physical dependence and withdrawal, retardation of growth, and neonatal respiratory depression with high doses (3rd trimester/labour issues). For these reasons, narcotic analgesics should be used only when clearly needed. Malformations have not been found with the use of codeine and pregnancy. However, it is recommended that you talk to your physician about pain control options during pregnancy to determine the best course of action given your gallstones.
References: 1. Micromedex

Jun. 29, 2017Is it safe for me to get a spray tan? details
 

Response: It's generally considered safe to use fake tan creams and lotions during pregnancy, but it's probably best to avoid spray tans (particularly in the 1st trimester) because the effects of inhaling the spray are not known. If you do decide to get a spray tan, make sure you use the nose plugs and a mask to avoid inhalation.
The active ingredient in fake tan is dihydroxyacetone (DHA). This is a non-toxic substance that reacts with cells in the outermost layer of the skin and produces a brown pigment (colour) called melanoidin. As the DHA isn't thought to go beyond the outer layer of skin, it isn't absorbed into the body and can't harm your baby.
Even though there are no known risks to your baby from using fake tans during pregnancy, there is a risk you could have an allergic reaction to them. This can happen because the changes in your hormone levels can make your skin more sensitive than normal. If you do use fake tan, always test the product on a small area of skin first, to see if you have a reaction.
References: 1. http://www.nhs.uk/chq/pages/955.aspx?categoryid=54&subcategoryid=131 Is it safe to use fake tan during pregnancy?
2. http://www.babymed.com/safety/how-safe-spray-tanning-pregnancy

Jun. 30, 2017Is fluoxetine safe in pregnancy? details
 

Response: You should speak to your doctor as you may need a switch in medication before your 3rd trimester. (Other SSRIs preferable in lactation)
Most studies indicate that SSRIs as a group are not major teratogens and are not associated with birth defects.

Human Data Suggest Risk in 3rd Trimester
Pregnancy Summary
The available animal and human experience indicates that fluoxetine is not a major teratogen. However, one animal study has shown that fluoxetine can produce changes, perhaps permanently, in the fetal brain. Moreover, the increased rate of three or minor anomalies found in one investigation may be evidence that the drug does adversely affect embryonic development. The other studies cited above lacked the sensitivity to identify minor anomalies because of the absence of standardized examinations. Two large case-control studies did find increased risks for some birth defects, but the absolute risk appears to be small. However, selective serotonin reuptake inhibitor (SSRI) antidepressants, including fluoxetine, have been associated with several developmental toxicities, including spontaneous abortions (SABs), low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral syndrome (withdrawal), possibly sustained abnormal neurobehavior beyond the neonatal period, respiratory distress, and persistent pulmonary hypertension of the newborn.
References: 1)Briggs
2)UTD - Risks of antidepressants during pregnancy: Selective serotonin reuptake inhibitors (SSRIs)
3)Lactmed

Jul. 3, 2017I saw my doctor and he said that I have anxiety with being a new mom. He said I do not have postpartum depression. He started me on quetiapine yesterday. I've noticed today that my baby is very drowsy - has been asleep for 6 hours which is not usual for her. Is quetiapine safe is breastfeeding? details
 

Response: Quetiapine is an odd choice for treatment of anxiety, based on what the caller is describing, and with the infants excessive drowsiness. Along with the Healthline nurse, we recommended she be reassessed by the doctor, and in the meantime, stop taking quetiapine.

The long-term effects of these exposures on nursing infants are unknown. The manufacturer recommends women receiving quetiapine should not breastfeed. Moreover, the American Academy of Pediatrics classifies other antipsychotics as drugs whose effect on the nursing infant is unknown but may be of concern.

Maternal quetiapine doses of up to 400 mg daily produce low levels in milk. Limited long-term follow-up of infants exposed to quetiapine indicates that infants generally developed normally. Systematic reviews of second-generation antipsychotics concluded that quetiapine seemed to be the first- or second-choice agent during breastfeeding. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
References: (1) briggs
(2) lactmed

Jul. 3, 2017What can I take for my cold other than Tylenol? Most bothersome symptom is dry cough, and some nasal congestion. details
 

Response: Pseudoephedrine, in the lowest dose and shortest duration possible is considered the decongestant of choice.
It may be prudent to avoid its use in the first trimester of pregnancy. Oxymetazoline and xylometazoline nasal sprays can be considered when used at appropriate doses for short durations.

Dextromethorphan is the preferred antitussive in both pregnancy and lactation. There is a lack of evidence of efficacy.
We also discussed some nonmedicial options for both congestion and cough ie lozenges, tea, steam etc.
References: (1) http://medsask.usask.ca/documents/newsletters/32.3%20Cough%20and%20Cold%20Medications%20in%20Pregnancy%20and%20Lactation.pdf

Jul. 3, 2017My husband and I will be travelling, starting tomorrow. I've always taken a homeopathic product for jetlag when I travel and I just want to make sure it's safe in pregnancy. Contains: arnica montana, bellis peremmis, chamomila, ipeaccuanha, licopodium cloz details
 

Response: There is lack of studies for homeopathic products and therefore the safety in pregnanacy cannot be guaranteed. Usually amounts of active ingredients are extremely low. I offered to check each ingredient but she had already decided to go without the jetlag pills this trip - wants to be extra cautious as it's an IVF pregnancy.
References: none

Jul. 4, 2017Can my wife take Plan B? She is breastfeeding. details
 

Response: Yes.
References: 1. Lexicomp - Levonorgestrel (Systemic) (Lexi-Drugs)
2. Canadian Pharmacist's Letter; The Art of Selecting & Prescribing Hormonal Contraception
Volume 2016, Course No. 246
Self-Study Course #160246

Jul. 5, 2017I have a fever. All I have is Tylenol 500mg tablets. Can I take those if pregnant? details
 

Response: Yes. At the regular adult dose. 1-2 tab every 4-6 hours as needed to a maximum of 8 tablets/day.
References: 1. Briggs

Jul. 7, 2017I am having a lot of nausea and vomiting since coming home from the hospital. Is there anything I can take to help with this, given I am 12 weeks pregnant? details
 

Response: Yes. I would recommend you take Gravol this evening. If it does not help with the nausea and vomiting you should return to the hospital for further evaluation and medication.
References: 1. Lexi-Comp

Jul. 7, 2017I am trying to conceive. My period is 8 days late. I went to the doctor on the 2nd day of my late period and the urine and blood test were negative for pregnancy. However, since July 1st, I have been very nauseated, sore breasts and exhausted (but not able to fall asleep). Is there anything I can take to help with my nausea and vomiting and insomnia that would be safe in case I actually am pregnant? details
 

Response: Yes. I would recommend that you take Gravol (dimenhydrinate) for nausea and to help you sleep. I would also recommend that you purchase a home pregnancy test, as it may show a positive now that it has been 8 days (compared to the 2 days when you went to the doctor). If you are pregnant, I would recommend that you get a prescription for Diclectin, as it is more commonly used in pregnany for morning sickness, and it will also cause some drowsiness.
References: 1, Lexi-Comp
2. Detail-Document #221112 PHARMACIST’S LETTER / PRESCRIBER’S LETTER November 2006 ~ Volume 22 ~ Number 221112

Jul. 12, 2017I have a few bites that are itchy can I use OTC hydrocortisone tonight? details
 

Response: Use a low potency topical steroid for one time use shouldn't be a concern in pregnancy.
References: lexi

Jul. 12, 2017My doctor prescribed betahistine for my dizziness. The information that came with it says to use with caution if breastfeeding. Is it safe? details
 

Response: There are no data on the amount of betahistine dihydrochloride in breastmilk. The drug has a low molecular weight and low protein binding which suggests that the drug would enter breastmilk readily. The drug does have a short plasma half-life of 3 to 4 hours, and the time to peak would be 3 to 5 hours. Betahistine would likely be compatible with breastfeeding, particularly now that your child is older.
I would recommend not to breastfeed until 4 hours after taking the betahistine allowing the first half-life to pass. Observe infant for allergic symptoms such as nausea, vomiting, diarrhea and skin rash.
Gravol may be a safer choice.
References: 1. Hale
2. Lexicomp
3. http://www.infantrisk.com/forum/forum/medications-and-breastfeeding-mothers/other-uncategorized-medications/498-betahistine

Jul. 12, 2017What can I take for my sore throat while breastfeeding? details
 

Response: Both acetaminophen and ibuprofen are considered compatible with breastfeeding at the usual adult dosing.
References: 1. MedSask doc: Cough and Cold Medications in Pregnancy and Lactation

Jul. 14, 2017I bought Option Plus Original eye drops in case my eyes get worse. Safe in pregnancy? details
 

Response: The human pregnancy experience with naphazoline is very limited and animal reproduction studies have not been conducted. In addition, reports describing the amount of drug in the systemic circulation after nasal or ophthalmic use have not been located. However, it is doubtful if appropriate short-term use results in clinically significant systemic concentrations. Thus, the occasional use of naphazoline does not appear to represent a risk to the embryo and/or fetus.
References: 1. Briggs

Jul. 20, 2017I have a yeast infection, and sent my brother to get me the 3 day vaginal treatment. He came home with CanesOral 1 capsule instead. Is that safe to take? details
 

Response: CanesOral is fluconazole 150mg

Fluconazole is acceptable in nursing mothers because amounts excreted into breastmilk are less than the neonatal fluconazole dosage.
A 12-week postpartum woman was given a single oral dose of fluconazole 150 mg. The highest milk levels were 2.9 and 2.7 mg/L at 2 and 5 hours after the dose. Milk fluconazole levels were 1.8 and 1 mg/L at 24 and 48 hours after the dose, respectively. The half-life in milk was about 30 hours.
Using peak milk level data from these two patients, an exclusively breastfed infant whose mother was taking 200 mg daily of fluconazole would receive a maximum of about 0.6 mg/kg daily, which is 60% of the recommended neonatal (<2 weeks) dosage and 20% of the dosage used in older infants for oral thrush.
References: (1) https://www.canesten.ca/en/products/
(2) lactmed

Jul. 21, 2017I am currently nursing my 11 month old child but since needing the hydromorphone the doctor told me not to feed. However, she is not taking anything (including frozen milk) and I'm getting worried. Also, I have been trying to pump but it is not going well and my breasts are getting hard. I am going into surgery today. How long do I have to wait before I can feed her? I last took 1x1 mg hydromorphone at 1:00 AM (called at 8:00 AM). I am taking Tylenol for the pain which seems to help more than the hydromorphone. details
 

Response: 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.
t-1/2 2-3 hours; tmax <1 hour
No pediatric concerns reported but monitor sedation, slowed breathing rate, pallor, constipation. The relative infant dose is 0.67% so the infant of a woman taking 4 mg q6h would ingest about 0.002 mg/kg/d, which is less than the recommended dose for infants and children with pain of 0.03-0.06 mg/kg/dose q4h.
References: 1. Lactmed
2. Medications and Mothers milk

Jul. 21, 2017Can I take something for constipation when breastfeeding? I have bisacodyl tablets here - Can I take them? details
 

Response: Yes. Bisacodyl is acceptable for use in lactation - for short term use only!
References: 1. Schaefer
2. Briggs

Jul. 23, 2017My daughter is about a month pregnant and very sick to her stomach. Could she take Gravol? details
 

Response: Yes. Gravol is considered compatible with pregnancy in all trimesters. If her nausea continues, there is something better to take that requires a prescription. She should see her physician.
References: 1. Briggs

Jul. 25, 2017What can I take for my cold while breastfeeding my 3 week old? Is echinacea ok?? details
 

Response: For sinus congestion, it best to avoid the oral decongestants like pseudoephedrine. They don’t harm the baby, but can reduce milk supply, which can be an issue if it’s already limited. The nasal spray decongestants, like those containing Xylometazoline or Oxymetazoline (Dristan or Otrivin), are safe to use while breastfeeding. Just do not use them for more than 3 days in a row, or they can make congestion worse.

For cough, the only product that may help are those containing Dextromethorphan. If it’s a low/no alcohol product, it is safe to use while breastfeeding. Dextromethorphan is usually fairly ineffective for a cough however, so I recommend just the usual cold remedies instead—tea, honey, soup, etc.

For a sore throat, acetaminophen at usual doses (500mg every 4-6 hours as needed) is safe while breastfeeding.

As for Echinacea, there is no information available for if it transfers into breastmilk, and what effect it may have on an infant. I would recommend avoiding.
References: 1. NMCD
2. Lexi
3. PL Letter, cough/col in preg/lact

Jul. 26, 2017I was given 2 x 400mg cefixime antibiotic as one dose. How long before this "dissolves"? I feel nauseous and I don't want to have to take this again. details
 

Response: Following oral dosing, cefixime attains peak serum levels in approximately 4 hours.
Taking 50mg Gravol (dimenhydrinate) would be OK.
References: 1)RxTx
2)Briggs

Jul. 27, 2017How long do I have to wait after pregnancy before I can start back on my birth control? details
 

Response: Usually you should wait until about 6 weeks, when lactation has stabilized. This is 3 months post partum, so it should be okay to start now, especially since you are no longer breastfeeding.
References: 1. Lexicomp
2. UpToDate

Jul. 28, 2017Is it safe for my partner to use marijuana for nausea while pregnant? details
 

Response: No. Marijuana is considered UNSAFE as it passes through the placenta and can reduce fetal growth. Marijuana use during pregnancy is also associated with childhood leukemia and fetal abnormalities. In addition to this, if you were to use marijuana off the street it is likely not pure and may contain additional chemicals that will harm the baby. I would recommend using Diclectin as it is considered safe in pregnancy.
References: 1. NMCD
2. Lexi-Comp

Jul. 29, 2017Is it safe to use Polysporin ear drops if I am 23 weeks pregnant? I've had a bad ear ache for a week now. details
 

Response: There is not enough information regarding the use of Polysporin ear drops in pregnancy to recommend its use. I would suggest you go to a clinic tomorrow morning for further assessment and treatment.
References: 1. Lexi-Comp

Jul. 31, 2017I am finding that the Diclectin is making me super drowsy all day and I want to try substituting plain Vitamin B6 for one of the doses at least. What is the dose? Are Tums, Metamucil (aspartame) and Diclectin all OK? How do I space them? details
 

Response: Vitamin B6 is used for management of nausea and vomiting associated with pregnancy, 10–40 mg daily divided, in a combination product also containing doxylamine. As a single agent, 25–50 mg of vitamin B6 every 8 hours orally has been used.

The upper tolerable limit of vitamin B6 is 100 mg/day; use caution when recommending doses above 100 mg/day.

All products are OK in pregnancy and there are no interactions, but separate the doses to avoid absorption issues.
E.g. Vitamin B6 in a.m., Metamucil about 2 hours after. Tums - try to give 2 hours between dosing this and Metamucil - take later in the day if possible.
Metamucil comes in a sugar containing formula if you wish to avoid too much aspartame while pregnant.
Pregnancy Summary:
Ingestion of aspartame-sweetened products during pregnancy does not represent a risk to the fetuses of normal mothers, or of mothers either heterozygous for or who have phenylketonuria (PKU). Elevated plasma levels of phenylalanine, an amino acid that is concentrated in the fetus, are associated with fetal toxicity. Whether a toxic threshold exists for neural toxicity or the toxicity is linear with phenylalanine plasma levels is not known. Women with PKU need to control their consumption of any phenylalanine-containing product. Because aspartame is a source of phenylalanine, although a minor source, this should be considered by these women in their dietary planning. The other components of aspartame—methanol and aspartic acid—and the various degradation products have no toxicity in doses that can be ingested by humans.

Polyethylene glycol (PEG) products can be used intermittently if needed.
Pregnancy Summary:
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 (numbers refer to the average molecular weight) are safe and effective and should be considered as first-line therapy for constipation in pregnancy.
References: RxTx
Briggs

Jul. 31, 2017For breastfeeding: Is Benadryl safe? Is Metamucil safe? Is PEG 3350/docusate safe? Is Lactulose safe? Is Tramacet safe? details
 

Response: Benadryl is safe for occasional use while breastfeeding. Only very low amounts get into the breast milk, and it does not suppress milk production. It could potentially make your baby tired/sedated, but even this is unlikely.

Metamucil is safe to take in any amount/duration while breastfeeding—it does not get absorbed into the breast milk.

For lactulose, docusate and PEG—there’s not much data about their use in breastfeeding, but they all basically stay entirely within the gastrointestinal tract, so they wouldn’t be expected to be absorbed into the breast milk. It should be fine to use these as needed, but if your baby starts having loose bowel movements with no known cause, these may be an issue.

For Tramacet, we typically recommend against using it when the baby is very young. Tramadol is metabolized into its active metabolite, which transfers into the breastmilk. Some momss metabolise tramadol into this active metabolite very quickly, which means more of it would be present in the breastmilk than expected. This would lead to high exposure of tramadol to your baby, causing severe sedation or breathing issues.

Now, if you’ve breastfed while taking tramadol previously and it has not caused problems, then occasional use is fine. The above is just a precaution if it’s not known if the mom is a fast metabolizer of the drug or not.
References: 1. Hale
2. Briggs

Jul. 31, 2017Is it normal to have itchy feet and hands if I am pregnant? What can I use? details
 

Response: There is no rash involved and I think this could be more serious. She hasn't discussed this with her doctor so I suggested she make an appointment so doctor could asses and prescribe something to help. She is in quite a lot of discomfort - says it feels internal so a cream is not going to help.

Research:
Intrahepatic cholestasis of pregnancy (ICP) occurs in the second and third trimester and is characterized by pruritus and an elevation in serum bile acid concentrations.
The cause of ICP is unknown, but genetic, hormonal, and environmental factors are likely involved. Environmental factors may also influence the expression of the disease.
The maternal prognosis in ICP is good. There does not appear to be an increased risk for postpartum hemorrhage when ICP is managed with ursodeoxycholic acid and planned delivery.
References: 1)UTD - Intrahepatic cholestasis of pregnancy

Aug. 2, 2017Can I use Tiger Balm or Voltaren Emulgel on my neck if breastfeeding? details
 

Response: Topical applications during breastfeeding are, in principle, acceptable as long as they are applied to a limited area of the skin and for a limited period of time. This applies to all topical treatments, as well as antiseptics and disinfectants, repellents, anti-infectives (topical antibiotics, antimycotics and virostatics), corticosteroids and topical anti-inflammatory drugs, astringents, antipruritics and keratolytics. (1)
References: 1. Schaefer - Drugs During Pregnancy and LactationThird Edition

Aug. 3, 2017What is safe in pregnancy for a yeast infection? In the past I have used the CanesOral (fluconazole 150mg) and Canesten Vag Cream. It seemed to work the best. details
 

Response: Of the 2 products, the vaginal cream has a rating of pregnancy B and the fluconazole is rated at C. The cream would be fine to use if you found it effective in the past.
Pregnant Women - Single-dose oral fluconazole 150 mg does not appear to increase the risk of congenital anomalies. There have been reports of multiple congenital abnormalities in infants whose mothers were treated with high dose (400-800 mg/day) fluconazole therapy for coccidioidomycosis (an unapproved indication). Exposure to fluconazole began during the first trimester in all cases and continued for three months or longer. Fluconazole should not be used in pregnant women unless the potential benefit outweighs the potential risk to the fetus.(1, 2)

Pregnancy Summary - The absorption of clotrimazole from the skin and vagina is minimal. Three large surveillance studies found no association between clotrimazole and birth defects. However, one study did find a significant increase in the risk of spontaneous abortions (SABs) with 1st trimester vaginitis treatment. A later study speculated that this effect might have been due to inhibition of the critical enzyme aromatase. Until there are more data regarding this possible association, the best course is to avoid the use of clotrimazole for vaginitis treatment in the 1st trimester or the application of the antifungal to large areas of skin at any time in pregnancy.(3)
References: 1)Lexicomp
2)RxTx
3)Briggs

Aug. 5, 2017I am having problems with plugged ducts and I was told to take lecithin. I am getting sleepy and so is my son. Can It be this supplement? details
 

Response: I was not able to find any reference to drowsiness and lecithin (1,2)
References: 1- natural medicines
2- Lactmed

Aug. 8, 2017I accidentally took my pills about 3 - 4 hours apart instead of closer to 12 hours apart. Is that OK? details
 

Response: The use of metronidazole for trichomoniasis or vaginosis during the 2nd and 3rd trimesters is acceptable. For other indications, metronidazole can be used during pregnancy if there are no other alternatives with established safety profiles.(1)
Just go back to regular dosing tomorrow. Don't take another dose today.(1)
References: 1.Briggs
2.Lexicomp

Aug. 9, 2017What can I take as a cough suppressant? I am reading that dextromethorphan is OK but wanted to confirm this. details
 

Response: Dextromethorphan is the preferred antitussive in both pregnancy and lactation. (1)
References: 1. MedSask doc: Cough and Cold Medications in Pregnancy and Lactation

Aug. 9, 2017Can I use a cough and cold product with DM and guaifenesin in my 2nd trimester? details
 

Response: The safety of these agents in pregnancy is not considered absolutely safe. There are not a lot of serious documented adverse effects associated with use in pregnancy but only suggest using if absolutely necessary. Also, limited efficacy for DM in cough (which was her primary symptom so therefore a safer option is to use salt water rinse or lozenges.
References: on call references

Aug. 10, 2017I got a prescription for doxycycline to take for 20 days today. The information on the bottle says not to take if breastfeeding. I am breastfeeding a 13 month old - bedtime only. details
 

Response: Doxycycline is considered compatible with breastfeeding especially now that you are only breastfeeding once daily. (1,2,3)
References: 1. Briggs
2. Schaefer
3. Hale

Aug. 10, 2017Can I use NIX to treat scabies? details
 

Response: According to the manufacturer, permethrin should not be used in children less than 2 years of age; however, guidelines in Canada, the USA and Britain recommend permethrin 5% cream or lotion as the treatment of choice for scabies in infants 2 months of age and older. It should be applied to the entire body including the head and face, left on overnight for 8 to 9 hours, washed off and treatment repeated in 7 days. An alternative (but less convenient) treatment is sulfur 7% in petrolatum (Vaseline) applied to the entire body, left on for 24 hours, washed off and reapplied three times. A third line alternative is crotamiton (Eurax) cream. It is not as effective as permethrin and there is less information about its use in infants. Use cotton mitts or socks on the hands of infants and young children to prevent them rubbing the cream or ointment into their eyes.

The mother must also be treated for scabies at the same time. Although the use of permethrin by breastfeeding women has not been studied, it is considered the treatment of choice for breastfeeding women. Because the drug is not well absorbed through the skin, very little ends up in the breast milk and it is recommended for scabies treatment with no interruption in breastfeeding. The manufacturer suggests that breastfeeding could be temporarily stopped while the mother is being treated but this can be very inconvenient and is not necessary. Wash the cream off the nipples before nursing and reapply after the baby is finished feeding.
References: medSask Consumer Q&A - Nov 2012

Aug. 10, 2017When can I start breastfeeding again? I wasa taking clindamycin - last dose 2 days ago. details
 

Response: Clindamycin t1/2 = 3hours (3)
You can start breastfeeding any time now.

Summary of Use during Lactation: Clindamycin has the potential to cause adverse effects on the breastfed infant's gastrointestinal flora. If oral or intravenous clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, but an alternate drug may be preferred. (1)
Three potential problems that may exist for the nursing infant are modification of bowel flora, direct effects on the infant, and interference with the interpretation of culture results if a fever workup is required. The American Academy of Pediatrics classifies clindamycin as compatible with breastfeeding (2)
References: 1)Lactmed
2)Briggs
3)Lexicomp

Aug. 12, 2017I got up this morning and thought I was getting my period - having menstrual cramps. I bought some Life brand naproxen menstrual pain. I really haven't been bleeding so now I'm thinking I may be pregnant. Would taking this product be safe in pregnancy? details
 

Response: Naproxen is considered compatible with pregnancy during the first and second trimesters. It should not be used in the 3rd trimester. I would advise only using Tylenol, however, as it the safest thing to use for pain/fever during pregnancy.
References: 1. MedSask doc Cough and Cold Medications in Pregnancy and Lactation
2. Briggs

Aug. 12, 2017I have a cough and it is hurting to cough since I had a C-section 2 days ago. I think I remember that dextromethorphan is safe to take when breastfeeding. Is it also Ok to take with the other medications I am on? details
 

Response: Yes, dextromethorphan is compatible with breastfeeding. It does not interact with any ot the other medications you are taking.
References: 1. MedSask doc Cough and Cold Medications in Pregnancy and Lactation
2. Lexi interactions

Aug. 12, 2017I have a migraine and without thinking I took 2 extra strength Tylenol. Is that safe? I am 26 weeks pregnant. details
 

Response: Occasional use of usual doses of Tylenol are compatible with pregnancy. (1)
References: 1. Briggs

Aug. 14, 2017My sister was treated for scabies about 2 weeks ago (and was infested). Her two sons were also treated. I also live with her but the doctor decided not to treat me because of my pregnancy. I'm now feeling quite itchy. I don't know if I have scabies or if I'm just paranoid. We have a tube of cream left.. Nix dermal cream. Would it be safe for me to use? She is itchy beside her knees and the backs of her upper legs, and well as crease of the neck. Her sister was diagnosed 3 weeks ago. details
 

Response: Timeline of symptoms onset and areas of itchiness do sound typical of scabies. No visible sores at this point.

Nix dermal cream (permethrin) is the recommended treatment in pregnancy. Based on the resources I consulted, pregnancy is not a reason to forego treatment.
References: (1) UTD
(2) RxTx

Aug. 15, 2017I have hemorrhoids and am 35 weeks pregnant and wondering what product may be safe to use? details
 

Response: In pregnancy, sitz baths and increasing fibre and fluid to prevent constipation will help the discomfort of hemorrhoids.
If needed, the safest option is to use an external cream such as Anusol (zinc sulfate monohydrate) instead of a suppository or product that is inserted into the rectum. Medications are well absorbed from the rectum and there is not a lot of safety data available in pregnancy and use of hemerroid products.
References: 1 - Patient self care - Hemorrhoids

Aug. 16, 2017Can I take aspirin? She also has Tylenol. details
 

Response: Tylenol is the safer of the 2 medications. If you need an anti-inflammatory, then Advil is OK while breastfeeding.

Summary of Use during Lactation:
Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or antiinflammatory agent in nursing mothers.

Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.


After aspirin ingestion, salicylic acid is excreted into breastmilk, with higher doses resulting in disproportionately higher milk levels. Long-term, high-dose maternal aspirin ingestion probably caused metabolic acidosis in one breastfed infant. Reye's syndrome is associated with aspirin administration to infants with viral infections, but the risk of Reye's syndrome from salicylate in breastmilk is unknown. An alternate drug is preferred over continuous high-dose, aspirin therapy. After daily low-dose aspiring (75 to 325 mg daily), no aspirin is excreted into breastmilk and salicylate levels are low. Daily low-dose aspirin therapy may be considered as an antiplatelet drug for use in breastfeeding women
References: Lactmed

Aug. 16, 2017Can I still use Diclectin for nausea or it is too late in my pregnancy? details
 

Response: Diclectin can be used in all stages of pregnancy.
References: 1. Briggs

Aug. 17, 2017Is the flouride treatment I got at the dentist OK for breastfeeding and possibly 1st trimester pregnancy? details
 

Response: Fluoride topical does not enter the breastmilk, so breastfeeding will not be impacted.
Also, even if you are pregnant, topical flouride treatments are not an issue.
References: 1. http://canadianfamily.ca/kids/pregnancy/dental-care-during-pregnancy-what-you-need-to-know/
2. Hale, Medsmilk

Aug. 19, 2017I was prescribed naproxen for pain control after my c-section. Is this safe to use if I am also breastfeeding? details
 

Response: Yes. Naproxen can enter the breast milk in very small quantities and the effects on the infant are not known. However, it is considered usually compatible with breastfeeding.
References: 1. Detail-Document #230412
PHARMACIST’S LETTER / PRESCRIBER’S LETTER
April 2007 ~ Volume 23 ~ Number 230412

Aug. 19, 2017Since becoming pregnant, I have developed hay fever symptoms and have been taking Reactine (cetirizine) daily. My symptoms are not controlled, so I was wondering if I could take Benadryl (diphenhydramine) in addition to the Reactine? details
 

Response: It is generally recommended to take one antihistamine, as the have the same mechanism of action. You may consider switching to loratadine tomorrow to see if you have better symptom control. Given your symptoms are quite bothersome, you could try one dose of benadryl tonight until you are able to buy an alternative product in the morning. If switching antihistamines does not help, I would recommend that you see your physician for further evaluation.
Note: both diphenhydramine and cetirizine are considered safe in pregnancy.
References: 1. Lexi-Comp

Aug. 21, 2017I'm currently on Effexor and breastfeeding. Can I take Benadryl for hives? details
 

Response: Yes, this is okay. Take 50mg Benadryl (diphenhydramine) now and every 6 hours if needed. Continue to watch the hives and call the Healthline if they continue to get worse, or see a doctor tomorrow if they're no better.
References: 1. Lexicomp

Aug. 22, 2017I am trying to get pregnant and not sure if I am yet. I may need a procedure and require general anesthesia. Is that safe in pregnancy? details
 

Response: Teratogenicity — Anesthetic agents have no known teratogenic effects, and multiple large retrospective studies have not shown an increase in congenital defects in infants born to mothers who had surgery and anesthesia during pregnancy, including the 2252 pregnancies with first-trimester exposures. Although many drugs used in anesthesia were associated with teratogenic effects in animal studies, this may not apply to humans due to species variation and the high dose of agents used in the animal studies.

Early reports suggested that diazepam use in early pregnancy may be associated with cleft palate; however, subsequent studies have failed to demonstrate this association or a definite risk of other anomalies, although a small increase in risk could not be excluded. Commonly used benzodiazepines (such as midazolam) have never been associated with congenital malformations.
References: Up to Date

Aug. 23, 2017I am having a gastroscopy today. If I decide to take the sedation, it is IV fentanyl and midazolam. Would these be safe for me if I am pregnant? details
 

Response: Fentanyl has been reported to cross the placenta readily in early pregnancy. No teratogenicity has been observed in animal experiments. Systematic studies on fentanyl use in early pregnancy are lacking, but until now no suggestion of teratogenicity exists.
The National Birth Defects Prevention Study discussed below found evidence that opioid use during organogenesis is associated with a low absolute risk of congenital birth defects.
Midazolam: Limited Human Data—Animal Data Suggest Low Risk
References: 1. Schaefer
2. Briggs

Aug. 23, 2017This is not working - I am throwing up all the time. I can't keep anything down. What can I do? details
 

Response: First of all, advised the caller to contact her doctor ASAP as she may be dehydrated and should be assessed - may need IV fluids. Advised also to drink hydration salts in the meantime with small sips. She can also take a Gravol tonight but should contact her doctor to determine an action plan.

The normal dose of Diclectin is 1 tablet bid with 2 tablets taken at bedtime to cover the next morning. She was only taking 1 tablet as needed. Advised her to take the Diclectin 2 tablets at bedtime. She can also eat small more frequent meals, ginger ale and experiment and find the foods that work for her to lessen the nausea.
She was adamant that nothing would work but I tried to reassure her that it would eventually pass.

She askd at this point if she could also take a powdered supplement from her health food store but she could not identify any of the ingredients or its name. I said I could not recommend that she take this in pregnancy without more information.
References: www.duchesnay.com Diclectin monograph
www.parents.com - tips to manage morning sickness
Personal knowledge - been there done that :)

Aug. 24, 2017What can I take for constipation when pregnant? I haven't had a bowel movement in 3 days. details
 

Response: For the quickest onset, recommend she try a glycerin or bisacodyl suppository (wanting something tonight). Encouraged prevention once this episode has resolved, with increased fibre in her diet and/or PEG as needed.

Constipation affects up to 25–30% of women in late pregnancy and up to 3 months postpartum. It is thought to be secondary to elevated progesterone levels causing muscle relaxation in the intestine. It may also be due to the use of calcium and iron supplements and the gravid uterus pushing on the colon. Dietary bran or wheat fibre is preferred as initial treatment of constipation during pregnancy to increase the frequency of defecation and soften stools. Docusate has traditionally been added if fibre supplementation has failed during pregnancy but there is little evidence to support this practice. Heavy mineral oil is not absorbed systemically but may impede vitamin or mineral absorption. If stools remain hard, consider adding or switching to lactulose or PEG. Stimulant laxatives are more effective than dietary or medicinal fibre therapy but cause more side effects of diarrhea and abdominal pain; they are reserved for short-term use when other agents have failed. Use stimulant and osmotic laxatives short term to prevent possible dehydration and electrolyte disturbances. Occasional use of glycerin or bisacodyl suppositories is also an option. One study found no association between senna and higher risk of congenital abnormalities in pregnant women.
References: (1) RxTx

Aug. 25, 2017Is Gravol OK if I'm pregnant? Can I take Womens' One a Day Gummies? details
 

Response: Yes Gravol is OK in pregnancy.
If the nausea becomes more severe or constant, discuss other options with your doctor.
Gummies?
Yes - these vitamins are OK, but check with your doctor if you should be getting more folic or iron.
References: 1)Briggs
2)https://www.oneaday.ca/en/products/gummies_women.php

Aug. 27, 2017I have a yeast infection and want to treat it. What are the best options for me if I'm pregnant? details
 

Response: Best to use clotrimazole or miconazole as first line therapy.

Failing this, Fluconazole is a safe option at 150mg X 1 dose, but likely best to try the cream first, given the mild symptoms.
References: 1. Lexicomp
2. RxFiles

Aug. 28, 2017Is Zoloft (sertraline 75mg) OK while breastfeeding? details
 

Response: Summary of Use during Lactation:
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. . Most authoritative reviewers consider sertraline one of the preferred antidepressants during breastfeeding. 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.
Lean toward sertraline. It doesn't seem to be strongly linked to birth defects...and is generally safe in breastfeeding.
References: 1)Lactmed
2)CPL - PL Detail-Document, Treatment of Depression in Pregnancy. Pharmacist’s Letter/Prescriber’s Letter. February 2016.

Aug. 28, 2017I am breastfeeding and want to know if I can have a spray tan. details
 

Response: It's generally considered safe to use fake tan creams and lotions during pregnancy, but it's probably best to avoid spray tans, because the effects of inhaling the spray are not known.

The active ingredient in fake tan is dihydroxyacetone (DHA). This is a non-toxic substance that reacts with cells in the outermost layer of the skin and produces a brown pigment (colour) called melanoidin. As the DHA isn't thought to go beyond the outer layer of skin, it isn't absorbed into the body and can't harm your baby.

Use nose plugs so you don't breathe in the spray. If it isn't absorbed then it won't enter the breastmilk so should be fine.
References: 1)http://www.nhs.uk/chq/Pages/955.aspx - Is it safe to use fake tan during pregnancy?

Aug. 29, 2017Can I take a Gravol for nausea tomorrow when I do some travelling? I am 12 weeks pregnant. details
 

Response: Yes - Gravol is considered safe in pregnancy. I would suggest you wait 4-6 hours between taking it and Diclectin as they work in similar ways as well you may be quite drowsy if you are to take both. Be cautious. (Don’t drive after taking Gravol)
References: lexi