Advice re lemsip when breast feeding

[Polly D]

Realise this comes under the danger area of requesting medical advice...but if I may ask the question: if I'm advised by chemist that only paracetamol can be taken with a cold when breastfeeding, why can't I take a lemsip? It contains paracetamol, and a decongestant. Assume it's the latter which is no good for the baby but what are the actual 'risks' for him? I'm so blocked up and feel pretty rotten, with a 12 week old and a very energetic nearly 4 year old...

Apologies if I'm not allowed to ask for med advice, do remove if so FRM!

[Cyberia]

Any chance you could stop in at a bf clinic or phone a helpline and ask a bf expert? There are some websites that also list medications that aren't recommended while breasfeeding though no idea if they are reliable. I vaguely remember reading something about certain decongestants interfering with milk production so might affect your milk supply - not sure about effect on the baby though.

[bluesuperted]

Yes decongestant can dry up your milk supply so I would definitely avoid unfortunately. The Breastfeeding Network has a great helpline (drug line or smth) where a lady can advise on all BF safe drugs. I've read anecdotally on forums that people have taken decongestants to make their milk dry up too... Have you tried paracetamol with honey/lemon/cloves/whiskey instead? I've also heard from a GP that lemsips etc don't have much advantage over standard paracetamol for helping relieve symptoms but like you I remember wishing I could just load up on them, placebo effect of the taste or whatever, when either BF or pregnant!

[Otta]

Mrs Otta has always used Lemsips whilst breastfeeding, with no issues. Not exactly a medical answer for you, but our girls are fine ;-)

[Pickle]

I've used them many times with no problems x

[bluesuperted]

http://www.breastfeedingnetwork.org.uk/drugs-in-breastmilk.html- info on drugline, it's an answer phone but I got a call back v quickly if I remember rightly.

[sanity girl]

If you want to avoid a decongestant try using a saline spray to clear your nose - worked well for me - there is one called Sterimar that is good

[Saffron]

http://jhl.sagepub.com/content/16/4/319.short

Nice et al (2000) Review: Breastfeeding and Over-the-Counter Medications

The seemingly simple topic of OTC medications can become quite complex in the breastfeeding population

and among health care professionals who, due to the increase in the incidence of breastfeeding, have the added responsibility of counseling nursing mothers. To minimize possible adverse effects of medications on breastfed infants, mothers should be counseled as follows:

1. Initially, recommend and encourage nonpharmacological therapy for symptoms.

2. Recommend either taking oral medications immediately after nursing or before the infant?s longest sleep period. This may minimize drug transfer through the breast milk by avoiding peak [blodd]plasma and milk drug levels.

3. Avoid recommending any medications that are extrastrength, maximumstrength, or long-acting; instead, recommend taking the lowest dose possible(usually marked regular strength).

4. Avoid recommending medications that contain a variety of different active ingredients.

5. Inform the mother to watch for any possible side effects that may occur in the child.

... ... ...

Cough, Cold, and Allergy Products

Cough, cold, and allergy products may contain a combination of decongestants, antihistamines, expectorants, antitussives, and pain relievers. It is important to be aware of each individual ingredient and determine its compatibility with breastfeeding. To prevent any possible side effects, it is recommended that breastfeeding

mothers avoid combination products (unless each active ingredient is safe), extra-strength products, or lon-gacting products.

Overall, antihistamines (H1-antagonists) are reasonably safe to use when breastfeeding. The common OTC antihistamines include diphenhydramine, brompheniramine,tripolidine,clemastine,chlorpheniramine,and dexbrompheniramine. Drowsiness and irritability have been reported while using clemastine. The other antihistamines may potentiate drowsiness in the infant. To avoid these side effects, it is best to take antihistamines at bedtime, after feeding the infant. Avoiding long-acting, combination, or high-dose antihistamines can also prevent these side effects.

The decongestants in most cold medications include pseudoephedrine, phenylpropanolamine, phenylephrine, or pheniramine. Only about 0.5% of the oral dose of pseudoephedrine is found in breastmilk over the course of 24 hours, and insignificant amounts of phenylephrine have been reported. According to the AAP, pseudoephedrine, found to be compatible with breastfeeding, is the preferred decongestant. However, mothers may experience a decrease in breast milk productionand therefore should drink extra fluids.

Guaifenesin and dextromethorphan have had no reported adverse events. Due to the small molecular weight of dextromethorphan, it probably passes into breast milk. Alcohol, used in some cough and cold elixirs, can be secreted into milk in concentrations similar to [blood]plasma. Even though the AAP considers alcohol compatible with breastfeeding, nursing mothers should avoid any products containing alcohol concentrations greater than 20% to 25%, to prevent adverse effects.

The AAP considers codeine compatible with breastfeeding; however, it can be excreted into breastmilk in small amounts. The mother should be directed by a physician or pharmacist on the use of this particular antitussive.

[Saffron]

However, Aljazaf et al (2003) did find that pseudoephedrine significantly decreased milk production, but they acknowledged that their conclusion was limited by small sample size: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2125.2003.01822.x/full

Aims  To assess the effects of pseudoephedrine on breast blood flow, temperature and milk production, and to estimate the likely infant dose during breastfeeding.

Methods  Eight lactating women (mean age 35 years and weight 69 kg) participated in a single-blind randomized crossover study of 60 mg pseudoephedrine hydrochloride vs placebo. Breast blood flow and surface temperature were measured from 0 to 4 h following the dose, and change in plasma prolactin was measured as the difference between predose and 1 h postdose concentrations. Milk production was measured for 24 h following placebo and pseudoephedrine. Infant dose of pseudoephedrine for a 60-mg dose administered four times daily to the mother was quantified as the product of average steady-state drug concentration in milk and an estimated milk production rate of 0.15 l kg−1 day−1 and expressed relative to the maternal weight-adjusted dose.

Results  There were no physiologically significant changes in breast blood flow or temperature between the placebo and pseudoephedrine periods. The mean change in plasma prolactin was slightly (13.5%), but not significantly lower (t = 1.245, P = 0.253) after pseudoephedrine (1775 mU l−1) compared with placebo (2014 mU l−1). However, the mean milk volume was reduced by 24% from 784 ml day−1 in the placebo period to 623 ml day−1 in the pseudoephedrine period (difference between means 161 ml day−1 (95% CI: 63, 259 ml day−1); t = 3.9, P = 0.006). Assuming maternal intake of 60 mg pseudoephedrine hydrochloride four times daily, the estimated infant dose of pseudoephedrine was 4.3% (95% CI, 3.2, 5.4%) of the weight-adjusted maternal dose.

Conclusions  A single dose of pseudoephedrine significantly reduced milk production. This effect was not attributable to changes in blood flow, but depression of prolactin secretion may be a contributing factor. At the maximum recommended pseudoephedrine doses, the calculated infant dose delivered via milk was < 10% of the maternal dose, and is unlikely to affect the infant adversely. The ability of pseudoephedrine to suppress lactation suggests a novel use for the drug.

[Saffron]

Yes, discuss with dr for medical advice, etc, etc. In the meantime, start with half a dose? See what your milk is like the next day?

One thing many studies (and some doctors!) fail to realise is that being ill in itself can diminish your milk supply. If a small dose of well-timed painkiller and/or decongestant would help you rest better, then the amount by which your supply could hypothetically be diminished by the drug might be offset by the amount your supply is increased by getting good rest. You could also think about taking a lactation supplement with the decongestant, like blessed thistle and fenugreek. Something to dicuss with a good lac consultant, I think!

I had a terrible respiratory infection after my daughter was born. I got fobbed off by a number of medical people who were probably genuinely ignorant of what drugs a lactating mother can/cannot take. I remember being in tears b/c I was told all I could have was a vicks stick. What utter bollocks. The amount of time I spent coughing & sniffing myself awake at night was surely worse for my milk than anything else! Hope you're feeling better soon. xx

[Pickle]

My rule of thumb tends to be:

If it states on the packet NOT to be taken by breastfeeding Mothers I steer clear

If it says "breastfeeding Mothers consult your doctor" I take it

3 kids, 3.5 years of breastfeeding, I haven't harmed anyone (noticeably) yet ;)

[Polly D]

Thank you so much everyone. Really helpful x

[jctg]

FWIW - I had the same query last week, my GP said paracetamol

or ibuprofen are absolutely fine on their own but to avoid cold remedies like lemsip etc because of all the other stuff in them. I usually make (whiskey free!) hot toddies and dissolve the paracetamol in them. Breastfeeding when ill is so exhausting so hope you get well soon.