Other Treatments

Pain Relief

Paracetamol

Paracetamol is a safe medication to take whilst pregnant and breastfeeding. If your baby is also taking paracetamol then it is okay for you to continue taking your own recommended dose as transfer into breast milk is minimal.

Anti-Inflammatories

Non-Steroidal Anti-Inflammatories (NSAID) such as ibuprofen, are safe medications to take whilst breastfeeding, although should be avoided in pregnancy. There are some contraindications to NSAID and so, if you have never taken them before, you should consult with your doctor to ensure they are suitable for you to take. If your baby is taking an NSAID, then it is okay for you to continue taking your own recommended dose as transfer into breast milk is minimal.

Opioids

Codeine, dihydrocodeine and morphine are opioid drugs, often prescribed if paracetamol and ibuprofen are not sufficient to control your pain levels.

Codeine is broken down into morphine by the liver, but how much codeine can be metabolised by the liver varies from person to person and is not easily predictable. If everyone took the same dose of codeine, we would all end up with different circulating levels of morphine, as the ability of our livers to break it down into morphine will differ.

Dihydrocodeine is also broken down to morphine by the liver, but in a different way that makes the resulting levels of morphine in an individuals blood easier to predict. It is for this reason that dihydrocodeine is preferred over codeine as a pain relief option for breastfeeding mothers.

Morphine is metabolised really quickly so is unlikely to reach the breastmilk in high levels.

Although morphine, and drugs that are broken down into morphine, can be used while breastfeeding, all of these medications can lead to increased drowsiness in your baby. For this reason, before taking any opioid medication, it’s really important that you speak to your health care professional.

You can find more information in Wendy Jones comprehensive factsheet on opioids and breastfeeding.

Anti-Sickness

There are a variety of anti-sickness and anti nausea medications available. Some of the more commonly prescribed ones include:

• Prochlorperazine (aka Stemetil or Buccastem) is a treatment for drug induced nausea and vomiting. Long term use is not advised when breastfeeding as it gets into the breastmilk and can lead to side effects in the baby.

• Domperidone is an anti sickness medication that can be taken when breastfeeding. It has lactogenic effects, i.e. it stimulates milk supply, so you may see an increase in production if taking it.

• Metoclopramide is an anti sickness medication, but is generally not recommended in young women due to the risk of side effects.

• Cyclizine helps prevent nausea and vomiting, but is not recommended for use if breastfeeding because , while evidence is limited, there have been concerns about side effects in infants.

• Ondansetron is an anti-sickness medication widely used in oncology patients, but is not compatible with breastfeeding.

You can find more information on these drugs and others in Wendy Jones comprehensive fact sheet on nausea and breastfeeding.

Steroids

Steroids are used to treat inflammation and certain types of pain. They may sometimes be given alongside anti-cancer drugs or radiotherapy to help prevent nausea and treat other side effects. Common steroids used in cancer care are prednisolone and dexamethasone. Taking up to 40mg of prednisoalone daily is compatible with breastfeeding, only small amounts have been found in breast milk and not enough to cause harm to infants.  

Hormone Therapy

Hormone treatments, such as tamoxifen, act to block the hormone signals that some cancer use to help them grow. They are commonly used in cancer treatment regimes, especially in women with a diagnosis of breast cancer,

Hormonal therapy drugs like tamoxifen, and their metabolites, are detectable in breastmilk and they build up over time. For this reason, it’s not advised to breastfeed while you are on this treatments. Hormonal therapy drugs can also suppress milk production so would likely make breastfeeding or pumping very difficult.

Alternative Medicine

Cannabidiol (CBD) Oil

CBD oil has become increasingly popular as an alternative treatment for pain and other ailments. Research on whether CBD oil can be found in breast milk is limited, but the risks are high so it is currently advised to avoid CBD oil if you are breastfeeding.

So, what are my feeding options?

If your treatment is delayed, you have an option to stock up your own milk prior to starting treatment. Once treatment has started, the stored breastmilk can be used. Other feeding options are donor breast milk and formula milk. You can feed your baby any combination of your own expressed milk, donor breastmilk or formula milk. Starting with one option and changing to another is also completely okay for your baby.

Depending on the variables, your treatment might be of short enough duration that it might be an option to pump & dump. By this we mean you could express your breastmilk (pump) to maintain your milk supply and then discard this milk (dump) whilst on the medication, and during the wash out period until you and your milk are drug-free. After this you can start breastfeeding again. Please speak to your oncologist about this option, but be aware that it is most likely they will say this is not an option, as the risks for your baby are too high and the demand on your body too great.