Human Milk Bank.ph would like to thank Wendy Jones, MRPharmS, of www.breastfeeding-and-medication.co.uk for her expert advice in compiling this information.

All drugs which we take have the potential to pass into breastmilk in varying amounts depending on the way the body handles the drug. In general only small quantities reach babies and term, fit and well babies can continue to be breastfed in the vast majority of circumstances.

Babies who will receive donor breastmilk are normally very premature and may well be poorly, so it is essential that the milk is as pure as it can be and free of any drug which may impact on the baby receiving it. The babies are also very vulnerable because their livers and kidneys, which have to deal with any drug to which they are exposed, are still very immature and not fully functioning. All babies born at term are more susceptible to drugs in the first 6 weeks of their life, a period in which we are careful about what drugs we use. Premature babies are vulnerable for much longer. It is also important that they don’t receive anything which may interact with medicines which they may be given directly.

We need to avoid any drugs:

• which reach babies in significant quantities
• which may cause drowsiness
• which might produce diarrhoea resulting in fluid loss e.g. antibiotics
• which might make it harder for the baby to breathe (when they may already be having respiratory difficulty)
• which might make them irritable or otherwise alter their behaviour
• which might change the balance of micronutrients and chemicals within the blood drugs which may increase the risk of infection

Please check with the milk bank before donating after taking any medicine which you buy from a supermarket or pharmacy even if they appear on the list below. and always write on the label of your breastmilk container any medications taken in the 24 hours prior to expressing even if on the accepted list:

• Paracetamol
• Vitamins
• Folic acid
• Head lice treatment
• Indigestion remedies / antacids
• Loratadine (Clarityn®) for hayfever
• Cetirizine (Zirtek®) for hayfever if Clarityn® does not work for you
• Nasal sprays to relieve symptoms of cold e.g. xylometazoline (Otrivine®), Oxymetazoline (Vick Sinex®)
• Nasal sprays and eye drops to relieve symptoms of hayfever e.g. Beconase®, Opticrom®
• Simple cough mixtures i.e ones which don’t cause drowsiness and don’t contain decongestants e.g. glycerine honey and lemon, simple linctus
• Sore throat lozenge e.g.Strepsils®, Lockets®, Tunes ®
• Loperamide (Imodium®) for diarrhoea
• Moisturisers to relieve symptoms of eczema e.g. E45®, Diprobase®
• Bulk Forming Laxatives e.g. Lactulose to relieve symptoms of constipation
• Osmotic Laxatives e.g. Magnesium Hydroxide to relieve symptoms of constipation
• Sofradex eye drops (dexamethasone and framycetin) for conjunctivitis. The eyedrops are safe to take and continue breastfeeding and donate your milk. Extra caution with hand hygiene is needed if you have conjunctivitis as it is so contagious so please make sure you don’t touch your eye/s between washing your hands and expressing your milk and as with any localised infection, washing your hands and your finger nails carefully before and after expressing your milk and again if you touch the site of the infection are very important.

• Treatments for threadworm- avoid donating for 48 hours (Ovex®, Vermox®)
• Aspirin containing products (Dispirin ®, Beechams Powders ®, some combination painkillers) – avoid donating for 36 hours if taken accidentally (should not be taken during breastfeeding at all but single doses are unlikely to cause problems to your own baby)
• Chlorpheniramine to relieve symptoms of allergy or hayfever (Piriton®)
• Nicotine patches or other nicotine replacements. Please see our FAQ for more information about nicotine and nicotine replacement therapies

Even if your GP has confirmed that you can continue to breastfeed your own baby, you should inform the milk bank of any medication you have been prescribed before continuing to donate, even if the medication is on the following list:

• Asthma inhalers to prevent symptoms e.g. steroids (brown inhalers) –beclometasone ( Clenil®, Qvar®, Asmabec®),Budesonide (Bricanyl®), Fluticasone (Flixotide®, Seretide®), Formoterol (No data is available on Formoterol’s transfer into human milk, but the extremely low plasma levels would suggest that milk levels would be incredibly low, if even measurable. Studies of oral absorption in adults suggests that while absorption is good, plasma levels are still below detectable levels and may require large oral doses prior to attaining measurable plasma levels. It is not likely the amount present in human milk would be clinically relevant to a breastfed infant)
• Asthma inhalers to relieve symptoms (blue inhalers ) – salbutamol ( salamol®, ventolin®), terbutaline, (Bricanyl ®)
• Levothyroxine to relieve symptoms of under active thyroid
• Progesterone only contraceptive pill
• Progesterone only contraceptive injection
• Progesterone only contraceptive IUD/coil (Mirena ®)
• Omeprazole
• Steroid creams to relieve symptoms of eczema in normal, sparing amounts (avoid applying to the nipples) Insulin

• Codeine and any medications that include codeine. If you have taken these please wait for 24 hours before donating
• Ibuprofen and any medications that include Ibuprofen. If you have taken these please wait for 24 hours before donating Baclofen (monitor babies under 2 months for signs of sedation)
• Sleeping tablets (seek advice before using when breastfeeding your own baby)
• Sedatives (seek advice before using when breastfeeding your own baby)
• Domperidone
• Tramadol – beware of drowsiness when feeding your own baby
• Codeine – beware of drowsiness when feeding your own baby
• Antibiotics (please temporarily stop collecting your milk for donation)
• Anti hypertensives
• Anti depressants
• Propothiouracil, Carbimazole to treat over active thyroid gland
• Mesalazine
• Metformin
• The anti-coagulant medication clexane (enoxaparin) and tinzaparin (Innophep) shouldn’t appear in the breastmilk of a mother who is injecting it, as it is such a large molecule. It is poorly bio available and therefore the amount passing into breastmilk is unlikely to be absorbed. However the potential risks to a baby on a NICU mean that, until further evidence is available, mothers using clexane (enoxaparin) should not donate breastmilk to a milk bank until at least 48 hours after they have stopped the medication. Milk bank staff should check with donors whether this medication was used and if so, carefully assess when the mother stopped taking it.
• Prednisolone, whether taken as a short course medication (eg for asthma) or in the much longer term (eg for psoriatic arthritis) will mean that a mother is not able to donate during the period of time she is taking it and for 24 hours after stopping.

Many people assume that a herbal remedy is not a medicine because it is “natural”. In fact many products can and do produce significant actions and thus side effects. Please check with your milk bank before taking any herbal remedies whilst donating.

• Fenugreek
• St Johns Wort
• Ginko boloba

Herbal fruit teas can be drunk in normal quantities. Please seek information from your milk bank if you drink any product which may result in transfer into breastmilk.

The following beauty treatments can be enjoyed whilst donating breastmilk:

• Hair dyes
• Hair perm or hair chemically straightened
• False nails fitted
• Massages with simple oils (please consult if any aromatherapy oils are used
• But donating after tattoos should be AVOIDED in case of the remote risk of acquiring an infection.

• Hepatitis vaccine
• MMR
• Anti D
• Flu vaccination

Please check with the milk bank to whom you are donating about any medication which you take before donating the milk and until then label your container with the drug you have taken and dose. Further information can be obtained from:

• The Breastfeeding Network Drugs in Breastmilk Helpline 0844 412 4665
• www.Breastfeeding-and-medication.co.uk
• Medicines Information at Local Hospital
• Regional Medicines Information Services (UKMI)

Which painkillers can I take whilst I am donating breastmilk? Whilst donating you should only take paractamol ( up to 8 x 500mg tablets in 24 hours). If you need to take any other medication e.g. ibuprofen, codeine, tramadol you should stop donating until 24 hours after you have stopped the tablets. You can continue to breastfeed your own child whilst taking all of these drugs but we cannot expose premature babies to a drug which may increase the risk of drowsiness or respiratory problems.

I would really like to donate breastmilk, but at the moment I am taking an antidepressant. If I stop taking my drug how long must I wait before I can donate?

It is really not a good time to try to stop taking antidepressants immediately after giving birth. This is a very stressful time with little opportunity to sleep. If you stop your medication now, you may find your mood drops quickly. Although donating your breastmilk may sound, and is, a really wonderful thing to do, you need to take care of yourself and your baby first. Maybe you can fundraise for the special care baby unit or find a different way to support mothers and babies.

I have been taking domperidone to increase my milk supply and now I have more milk than my baby needs, can I donate the excess to the milk bank?

It is really good to hear that you now have a good milk supply but unfortunately you cannot donate your milk. Although very little domperidone passes into breastmilk, it is a drug which cannot be given to babies who have any heart problems. It is not possible to label all milk with any drugs which may be present so we cannot accept milk which may have even a trace of domperidone. Similarly fenugreek, a herb used to increase breastmilk supply, has several interactions and cannot be given to premature or sick babies other than via their own mother’s milk where we are aware of what she is taking.

I need to have minor (day) surgery. When can I start to donate again?

General anaesthetic has a very short half life in the body, and it is usually safe to breastfeed your own baby very soon after surgery. The Breastfeeding Network has a useful information sheet to help mums in this situation (click here). However, because of the small amounts of anaesthetic that will take a little longer to leave the body, which would be fine for a healthy, term baby (although they may make him a little sleepy), it is important to wait for 72 hours after surgery before donating milk to a milk bank, as trace amounts of the drugs may affect tiny, premature babies more seriously, or interfere with the drugs they’re already being given.