Breastfeeding and medicines
On this page you will find information and resources on prescribing in patients who are breastfeeding
Medicines in Pregnancy, Children and Lactation
In accordance with NICE NG194, UNICEF’s baby friendly initiative and WHO guidelines mothers and parents should be supported to breastfeed their child. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age and beyond. Breastmilk is acknowledged as being the optimal way to feed all babies including in developed countries.
Health professionals should recognise that there may be adverse health consequences for both parent and baby if breastfeeding isn't protected. They should also recognise that it may not be easy to stop breastfeeding abruptly – and that it is difficult to reverse once stopped.
The Summary of Product Characteristics may not include after market evidence-based for information on lactation in specific drugs. It is important to use the resources linked below when making a shared decision with your patient on treatment options.
Don't Say Stop- Look it up!
Seek expert trained breastfeeding support when presented with breastfeeding problems so support can address issues, avoiding medicalisation and inappropriate diagnosis of conditions which will be corrected with appropriate skilled support.
Clinician Support and Resources
- Specialist Pharmacy Service (SPS): Advising on medicines regimens during breastfeeding (UKDILAS- UK Drugs In Lactation Service). The specialist UKDILAS service from SPS provides evidence-based information and advice to healthcare professionals on the safe use of medications in lactation, details for enquiries can be found on the Breastfeeding enquiries page.
- Drugs and Lactation Database (Lactmed) The Drugs and Lactation Database contains information on drugs which may be used in lactation, a US resource cited by NICE PH11 for use as a suitable supplementary resource for prescribers.
- The Breastfeeding Network Drugs Factsheets provided by the Breastfeeding Network Drugs in Breastmilk service, providing evidence-based information covering the most common issues affecting parents.
- Breastfeeding problems | Health topics A to Z | CKS | NICE Last revised in February 2025. See the NICE CKS updated information on the management of breastfeeding problems including breastfeeding pain from NICE CKS on breastfeeding problems.
- Patients may come to their pharmacist or GP for more information on up coming procedures, the Guidelines for anaesthesia and sedation for patients who are breastfeeding - Mitchell et al - 2026 - Anaesthesia - Wiley Online Library informs pragmatic advice and evidence base.
The Somerset Medicines Management Team are pleased to share an Introduction to Breastfeeding and Safety of Prescribing in Lactation training. We will be recording a webinar to compliment this material with the Infant Feeding Leads from Yeovil District Hospital and Somerset Foundation Trust.
Somerset Medicines Management Information on Lactation and Safe Prescribing March 2025
- Breastfeeding and Medication learning resources – written by Dr Wendy Jones MBE, this resource includes the Pharmacokinetics and transport of drugs into breastmilk presentation as well as some other very valuable presentations that may be relevant to your practice.
- GPIFN is a resource put together by GPs. This has many very useful links and CPD opportunities suitable for all health care professionals.
- eLearning for Healthcare- Infant feeding resource.
- ABM link to breastfeeding training for professionals.
- How to advise women on the safe use of medicines while breastfeeding article in the Pharmaceutical Journal published in June 2021 written by Dr Wendy Jones MBE to share information for healthcare professionals.
- Guidance sheets for providing remote care during the Covid-19 outbreak
- Unicef e-learning for GPs page.
CKS Breastfeeding Problems refers to the Breastfeeding Network Drug Factsheets which contain evidence based information on the most common issues with medicines and lactation. A popular resource endorsed by many breastfeeding support groups. Parents may attend a consultation with a print out or link to this. The National Breastfeeding Helpline offers breastfeeding support on the phone, and social media 24 hours a day, every day of the year: 0300 100 0212.
Information by Category or Condition
It is important to seek support from suitably qualified individuals when managing breastfeeding problems.
CKS Breastfeeding Problems outlines guidance on scenarios and how to manage them and links to local and national support; includes engorgement, blocked ducts, galactocele, ductal infection, mastitis or breast abscess, nipple damage, skin conditions, nipple vasospasm or Raynaud’s disease of the nipple, low milk supply and milk oversupply.
BMJ: Providing effective evidence based support for breastfeeding women in primary care
How to advise women on the safe use of medicines while breastfeeding Dr Wendy Jones MBE links to the Pharmaceutical Journal article published in July 2021
The Breastfeeding Companion: Common Hurdles A useful NHSE approved resource which discusses various breastfeeding hurdles including nursing strike, breast abscess, breast engorgement, tongue tie, overactive letdown, increasing supply, breastfeeding and jaundice, baby not latching, comfort nursing, sore nipples, nipple blanching, breastfeeding while sick, milk blister, breastfeeding at night, mastitis, blocked milk ducts, white spots on the nipple and more.
See the Infant Feeding Page for information on parental diet when feeding a baby with Cow’s Milk Protein Allergy, or a dairy free diet.
First Steps Nutrition have resources on eating well for new mums including information for breastfeeding mothers which has further detailed information on breastfeeding with special diets, including sources of calcium for a dairy free diet while breastfeeding.
See Vitamin D for more information on vitamin D supplementation needs for children and breastfeeding parents.
Trans or non-binary people can be supported to feed their babies human milk if that is their goal.
The NHS website has some useful information discussing chestfeeding, top surgery and binding while lactating.
Some more information is available in the Somerset Medicines Management Information on Breastfeeding and Safe Prescribing document found above in GP Education.
Cardiovascular Health in Lactation
Using oral anticoagulants in breastfeeding from Specialist Pharmacy Service December 2024
Cardiovascular Disease, the Circulatory System and Breastfeeding - The Breastfeeding Network June 2025
Raised cholesterol and breastfeeding from the Breastfeeding Network Drug Factsheets
Using lipid-lowering medicines during breastfeeding from Specialist Pharmacy Service
NICE NG133- This guideline covers diagnosing and managing hypertension (high blood pressure), including pre-eclampsia, during pregnancy, labour and birth. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. It aims to improve care during pregnancy, labour and birth for women and their babies.
Safety in Lactation: Drugs for hypertension from Specialist Pharmacy Service
Using angiotensin-II receptor antagonists during breastfeeding from Specialist Pharmacy Service
Using ACE inhibitors during breastfeeding from Specialist Pharmacy Service
Using beta-blockers during breastfeeding from Specialist Pharmacy Service
Using calcium-channel blockers during breastfeeding from Specialist Pharmacy Service
Cardiovascular Disease, the Circulatory System and Breastfeeding - The Breastfeeding Network June 2025
Information by Category or Condition
There is insufficient evidence to support a diagnosis of Candidiasis of the nipple or breast as the cause of pain when breastfeeding. Use evidence based resources and appropriately trained breastfeeding supporters to explore reasons for pain while breastfeeding.
Dry skin conditions of the breast shouldn’t be mistaken for fungal or thrush infections. Diagnosis | Diagnosis | Fungal skin infection – body and groin | CKS | NICE discusses diagnosis of fungal skin infections. Fungal treatment for fungal skin infections can be found in the Infection Management – Somerset ICB guidance.
Fungal infections and Breastfeeding - The Breastfeeding Network June 2025
Dry skin can cause itching, redness, and it may crack. It can affect all areas of the body but most frequently the hands, inside the elbows and behind the knees. The breastfeeding Network discusses dry skin in their factsheet: Eczema and Breastfeeding – The Breastfeeding Network. Dry or damaged skin should be protected with frequent emollient use, the emollient guidance can be accessed on the dermatology page. Nipples can be protected with a little expressed breastmilk, or cream/ ointment such as petroleum jelly, when applied sparingly after a feed, there should be no residue, so the skin doesn’t become soggy and there is no need to wash off any remaining cream.
For information on Candida of the female genital tract, follow guidance found in the NHS Somerset ICB - Management & treatment of common infections - Guidance for Primary Care guidance. NICE - CKS - Candida - female genital also discusses the condition. Be mindful that there may be variations in licencing of usual self-care OTC treatment options for patients while they are breastfeeding.
Dry skin conditions of the breast shouldn’t be mistaken for fungal or thrush infections.
Diagnosis | Diagnosis | Fungal skin infection – body and groin | CKS | NICE discusses diagnosis of fungal skin infections. Fungal treatment for fungal skin infections can be found in the Infection Management guidance.
Dry skin can cause itching, redness, and it may crack. It can affect all areas of the body but most frequently the hands, inside the elbows and behind the knees. The breastfeeding Network discusses dry skin in their factsheet: Eczema and Breastfeeding – The Breastfeeding Network.
Dry or damaged skin should be protected with frequent emollient use, the emollient guidance can be accessed on the dermatology page. Nipples can be protected with a little expressed breastmilk, or cream/ ointment such as petroleum jelly, when applied sparingly after a feed, there should be no residue, so the skin doesn’t become soggy and there is no need to wash off any remaining cream.
Mild dry skin may be treated as self-care, diagnosed skin conditions such as eczema needing emollients should follow the emollients guidance on the Dermatology page.
Please see our Medication Safety page and Medicines in Pregnancy page for prescribing to people of childbearing potential with epilepsy.
Safety in Lactation: Control of epilepsy from Specialist Pharmacy Service (under review)
Using gabapentin or pregabalin during breastfeeding from Specialist Pharmacy Service April 2023
Using antihistamines during breastfeeding from Specialist Pharmacy Service
Safety in Lactation: Drugs used in nasal allergy from Specialist Pharmacy Service
See our menopause webpage for further resources around menopause and hormone replacement therapy.
Breastfeeding and HRT – local oestrogen:
Breastfeeding and Oestrogen cream or pessary
Breastfeeding and HRT – Progestogen:
Hormone replacement with systemic oestrogen increases the risk of endometrial hyperplasia and endometrial cancer, a progestogen is necessary to protect the endometrium and reduce this risk.
Mirena® 20 micrograms/24 hours intrauterine delivery system (LNG-IUD) can be used as protection from endometrial hyperplasia during oestrogen replacement therapy. Mirena is should be replaced after 4 years for the endometrial protection. See the the Somerset formulary contraception chapter for more information on other indications and licenced length of treatments. LNG-IUD will provide contraceptive cover as well as endometrial protection which is an added benefit.
Micronised progesterone (body similar) is not licenced while breastfeeding, but is considered compatible. Use Lactmed and other specialist resources for evidence based information.
Breastfeeding and Medication – The Menopause and Breastfeeding
People with premature ovarian insufficiency will be offered sex steroid replacement with a choice of HRT or a combined hormonal contraceptive (CHC). CHC (unless contraindicated) has the added benefit of providing contraceptive cover to people with premature ovarian insufficiency.
For people who are perimenopausal, or menopausal, needing contraception see the FSRH Clinical Guideline: Contraception for Women Aged over 40 Years
Please see the Mental Health Page for more information on Perinatal Mental Health in including NHS Somerset’s guide to preferred antidepressants while pregnant and lactating as well as further resources for healthcare professionals and parents.
Non-opioid pain relief should be used where appropriate, where opioid pain relief is necessary specialist resources should be used including the Specialist Pharmacy Service links below:
Using codeine, dihydrocodeine or tramadol during breastfeeding from Specialist Pharmacy Service
Using strong opioid analgesics during breastfeeding from Specialist Pharmacy Service
Codeine is contraindicated while lactating. See MHRA Drug Safety Update: Codeine: very rare risk of side-effects in breastfed babies
The NHS webpage on Breastfeeding and Medicines provides some basic information for the public including paracetamol and ibuprofen.
Using gabapentin or pregabalin during breastfeeding from Specialist Pharmacy Service
See our Thyroid Conditions webpage
Treating urinary disorders during breastfeeding From the SPS June 2023
Vitamin D should be taken for the duration of lactation. Advise breastfeeding and chestfeeding people to take Vitamin D 10 micrograms per day. PH56 Vitamin D: supplement use in specific population groups. Also suitable for self-care.
The Department of Health recommends that:
- Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms (µg) of vitamin D to make sure they get enough. This is whether or not you’re taking a supplement containing vitamin D yourself.
- Children aged 1 to 4 years old should be given a daily supplement containing 10µg of vitamin D.
- Babies being combination fed breastmilk and formula receiving over 500ml of formula per day do not require additional vitamin D supplementation.
Treatment of deficiency (Vitamin D <25nmol/l) formulary options available on the Somerset Prescribing formulary. A daily dose of 4,000iu daily for 10 weeks is preferred while lactating. The Specialist Pharmacy Service discuss using vitamin D while breastfeeding, including deficiency states.
Healthy Start vitamins are available for families who qualify for free, see how to apply. Healthy Start women’s vitamin tablets contain folic acid and vitamins C and D (Children’s drops also available). FAQs. The application form must be signed by a midwife, health visitor, doctor or nurse.
The information and links provided are for guidance, clinical decisions remain the responsibility of the practitioner; the intention is to help prescribers find evidence based information and does not replace input from appropriate professionals or constitute medical advice for individual patients.
