Medicine safe while breastfeeding: painkillers, cold remedies, antibiotics and herbs, and what to check first

You can usually find a medicine safe while breastfeeding for a headache or a cold. SingHealth Polyclinics says most medicines reach breast milk only in tiny amounts. Its list of breastfeeding-safe medicines includes paracetamol, ibuprofen and common antibiotics. The ones to check first are cold and flu remedies with pseudoephedrine or codeine, and herbal remedies.

What to do before you take any medicine while breastfeeding, step by step

1. Tell every doctor and pharmacist you see that you're breastfeeding, dentists included. The NHS also asks you to mention if your baby was premature or had jaundice at birth, as that may change what you can take.
2. Check before you stop breastfeeding for a medicine. SingHealth Polyclinics says many mothers are wrongly told to stop, and suggests asking your doctor for a breastfeeding-safe alternative instead.
3. Read the active ingredients on the box, not just the name on the front. HealthHub says not to take paracetamol with any other product that contains paracetamol, so check cold and flu sachets before you add a painkiller.
4. Look for pseudoephedrine and codeine in cold and cough remedies. SingHealth Polyclinics says pseudoephedrine can decrease milk supply, and HSA advises nursing mothers to take care with codeine.
5. Ask the pharmacist before you buy over-the-counter medicines or herbal products. SingHealth Polyclinics' own advice, if you're unsure about any medicine, is to check with your doctor or pharmacist.
6. Pick a cream, eye drop, nose spray or inhaler when it will do the job. SingHealth Polyclinics says medicines used on the skin, eyes or nose, or breathed in, are almost always safe for breastfeeding.
7. Watch your baby in the days after you start something new. HSA's codeine advice is to get medical help straight away if your baby gets unusually sleepy, has trouble feeding, has trouble breathing or goes limp.
8. Keep taking any medicine your doctor prescribed. The NHS says not to stop a prescribed medicine without talking to your doctor, so ask about switching instead.
9. Express regularly if your doctor asks you to pause breastfeeding. SingHealth Polyclinics says this keeps your supply going, though you might need to throw that milk away until your doctor says you can restart.

How much medicine gets into breast milk

Less than you'd think. SingHealth Polyclinics says the level of a medicine in your milk is much lower than the amount you take, and only very few medicines cause problems for babies. The NHS says the same: the amounts are generally very low, and very few medicines are unsafe while you're breastfeeding.

KKH's lactation team notes that breast milk also carries your antibodies, which act against bacteria and viruses. A few medicines need a longer talk with your doctor. If you take medicine for depression or anxiety, our guide to antidepressants in pregnancy and breastfeeding covers how Singapore doctors choose. For birth control, see contraception after giving birth.

Medicines while breastfeeding in Singapore, by what you need

SingHealth Polyclinics and KKH publish a short list of commonly used medicines considered safe during breastfeeding. Here it is by need, with the checks other official sources add. Doses come from the label, your pharmacist or your doctor.

The polyclinic list gives examples, not every safe medicine. If yours isn't on it, ask your pharmacist. For your baby's own medicines, see the baby medicine and first aid kit checklist.

Cough and cold medicine while breastfeeding

Cold and flu products need the closest look, since one sachet or syrup can hold more than one medicine.

Pseudoephedrine is the decongestant to watch. LactMed, the US National Institutes of Health's breastfeeding medicines database, says a single dose lowers milk production and repeated use seems to interfere with it. It advises against pseudoephedrine for mums with a newborn whose supply isn't settled yet, or who are struggling to make enough milk.

Codeine needs care too. HSA says it's registered in Singapore for pain and for cough and cold, so it turns up in some syrups and painkillers here. Your body breaks it down into morphine, which can pass into breast milk, and HSA asks nursing mothers to take care with it.

Some cold remedies also hold a drowsy antihistamine such as chlorpheniramine. LactMed says larger doses or longer use might affect your baby or your milk supply, especially alongside pseudoephedrine, and that non-drowsy antihistamines are preferred. For the cough itself, LactMed says dextromethorphan syrup reaches milk in very low amounts, but to avoid products high in alcohol.

If your supply dips after a cold, our guide to increasing breast milk supply has what KKH and HealthHub suggest.

Painkillers, antibiotics and medicine after birth

HealthHub's postnatal leaflet lists what you may be prescribed after delivery: paracetamol, an anti-inflammatory painkiller such as mefenamic acid, naproxen or ibuprofen, a stomach protectant, iron and a laxative. HealthHub says to take the anti-inflammatory painkillers after food. It also says not all of them are safe for breastfeeding, so check any that isn't on its list with your doctor or pharmacist.

Antibiotics are usually fine. The NHS includes most antibiotics among medicines you can take while breastfeeding. If yours are for a breast infection, our mastitis guide covers feeding and pumping while you recover.

Dental work and surgery rarely mean a break from feeding. The NHS says dental treatment, local anaesthetics and most operations are fine. After a general anaesthetic, SingHealth Polyclinics says you can breastfeed as soon as you're awake and up to it.

Herbal remedies, TCM and confinement tonics

Herbs are the group Singapore's sources ask you to hold back on. KKH's lactation team advises avoiding traditional or herbal remedies while breastfeeding, because a baby's immature system may be sensitive to some of their components. The NHS says not enough is known about herbal remedies to be sure they're safe when breastfeeding.

Fenugreek is a herb HealthHub does name: it's among the milk-boosting medicines a doctor may prescribe, and KKH says to take it in moderation and ask your doctor or lactation consultant if you're unsure. If a grandparent or helper cooks tonic soups for you, tell them which herbs you're skipping. Our guide to confinement herbs covers dang gui and ginseng, and what to eat while breastfeeding covers kopi and alcohol.

When to see a doctor

Get help quickly if you notice any of these after you start a medicine:

• Your baby is unusually sleepy, has trouble feeding, has trouble breathing or is limp. HSA says these signs need immediate medical attention when a breastfeeding mum takes codeine.
• Your face, eyes, lips or tongue swell, you get a rash or you find it hard to breathe. HealthHub lists these as drug allergy signs: stop the medicine and get medical help straight away.
• You took more than the recommended dose. HealthHub says to seek medical advice immediately.
• Your milk supply drops after a cold remedy. LactMed links pseudoephedrine with lower supply, so see your GP or KKH's lactation team.

For yourself, start with your GP or polyclinic. For your baby, see a GP or polyclinic doctor for most problems, and go to KKH Children's Emergency or NUH Children's Emergency if it's urgent. KKH says to call 995 in an emergency, such as a baby who has trouble breathing, has a seizure or can't be woken.

Frequently asked questions

Can I take paracetamol while breastfeeding?

Yes, in general. SingHealth Polyclinics lists paracetamol among medicines considered safe during breastfeeding. HealthHub says not to take it with any other product that contains paracetamol, so check cold sachets too and take the dose on the label.

Can I take cough and cold medicine while breastfeeding?

Often, yes, once you've checked the ingredients. Take care with pseudoephedrine, which SingHealth Polyclinics says can decrease milk supply, and with codeine, as HSA advises. LactMed says dextromethorphan cough syrup isn't expected to affect your baby. Your pharmacist can suggest one that fits.

Can I take antibiotics while breastfeeding?

Usually, yes. SingHealth Polyclinics lists amoxicillin, cephalexin, cefuroxime, tetracycline and doxycycline as considered safe, and the NHS says most antibiotics can be taken. Tell the doctor who prescribes them that you're breastfeeding.

Where can I check medicines while breastfeeding in Singapore?

Ask your pharmacist or polyclinic doctor, and tell them you're breastfeeding. For feeding questions, KKH's Lactation Service is on 6-CALL KKH (6-2255 554). Leave your details with the operator and a lactation consultant calls you back.

Do I need to pump and dump after taking medicine?

Usually not. SingHealth Polyclinics says most medicines appear in breast milk only in tiny amounts. If your doctor does ask you to pause, express regularly to keep your supply going, and ask when you can start again.