Nonpharmacological intervention for nausea is preferred and includes practices such as smaller meals, a bland diet, and hydration. Antihistamines including meclizine, doxylamine, and diphenhydramine should be avoided because of the milk-supply-lowering anticholinergic effects.17,19 Occasional low doses of hydroxyzine are not likely to have any adverse effects on the infant. Limited data is available for metoclopramide, ondansetron, and phenothiazines. If these are used, the infant should be monitored for drowsiness.
There are limited data about the use of simethicone for flatulence, but it is minimally absorbed.18 Loperamide for diarrhea is considered compatible with breastfeeding. Magnesium hydroxide (milk of magnesia), bisacodyl, and senna are preferred pharmacologic agents for constipation.
Calcium-containing products such as calcium carbonate are acceptable for gastroesophageal reflux disease in lactating women.19 Famotidine is preferred if an H2 antagonist is preferred for longer-term use because it is excreted in a smaller amount compared to other products in the class. Proton pump inhibitors such as 20 mg of esomeprazole and omeprazole or 40 mg of pantoprazole have not been shown to cause adverse effects in babies and are only slightly excreted in breastmilk. Use of sucralfate for peptic ulcer disease and gastroesophageal reflux disease is considered acceptable due to its low absorption potential.
Pharmacists are well-positioned to influence new mothers to continue with breastfeeding. Patient education can include providing information on the benefits of breastfeeding, offering referral and education to address complications with lactation, selecting products to enhance nutrition in the breastfed infant, and identifying the safest drug selection and schedules to minimize infant exposure.
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