Safe Medications While Breastfeeding

Dr. Thomas Hale’s “Medications & Mothers’ Milk” is a widely used reference for the safety of drugs and other substances during breastfeeding. It classifies medications based on their risk to breastfeeding infants using a Lactation Risk Category (LRC) system.

Hale’s Lactation Risk Categories:

  1. L1 (Safest): Extensive studies show no risk to breastfeeding infants.
  2. L2 (Safer): Limited studies show minimal risk.
  3. L3 (Moderately Safe): No controlled studies or possible mild effects.
  4. L4 (Possibly Hazardous): Evidence of risk, but benefits may outweigh risks in serious conditions.
  5. L5 (Contraindicated): Significant risk—do not use while breastfeeding.
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Allergy Medications

  • Antihistamines (First Generation):
    • Chlorpheniramine (Chlor-Trimeton) – L3
    • Diphenhydramine (Benadryl) – L2
  • Antihistamines (Second Generation):
    • Loratadine (Claritin) – L1
    • Cetirizine (Zyrtec) – L2
    • Fexofenadine (Allegra) – L2
    • Desloratadine (Clarinex) – L2
  • Saline Nasal Sprays – L1
  • Ipratropium – L2
  • Cromolyn Sodium – L2
  • Benadryl – L2

Allergy Eye Drops

  • Antihistamine Eye Drops:
    • Ketotifen (Zaditor) – L3
    • Olopatadine (Pataday, Patanol) – L2
    • Cromolyn sodium (Crolom) – L2

Cough and Cold

  • Decongestants (Topical Nasal Sprays):
    • Oxymetazoline (Afrin) – L3 (limit use to under 48 hours)
    • Pseudoephedrine (Sudafed) – L3 (limit use to under 48 hours, studies have shown some decrease in milk production. Patient’s with low milk supply should be cautious in using.)
  • Cough Suppressants:
    • Dextromethorphan (Robitussin DM, Delsym) – L3 (short-term use)
  • Expectorants:
    • Guaifenesin (Mucinex, Robitussin) – L3

Cough and Cold Rubs

  • Mentholated Rubs:
    • Vicks VapoRub – L3

Cough Drops

  • Common Options:
    • Halls Cough Drops – L1

Sore Throat Relief

  • Lozenges & Sprays:
    • Throat lozenges with honey, lemon (menthol-based) L3
    • Tylenol Sore Throat (acetaminophen-based) – L1

Anti-Itch Creams

  • Topical Hydrocortisone Cream:
    • Hydrocortisone 1% (Cortaid) – L2
  • Calamine Lotion – L1
  • Aloe Vera Gel – L3

Lice Treatment

  • Permethrin (Nix) – L2
  • Pyrethrins (Rid) – L3
  • Dimethicone (Lice Clinics of America) – L3
  • Olive oil or coconut oil – No Hale’s Drug Classification

Pain Relief

*Long-term chronic use is not advised.

  • Acetaminophen (Tylenol) – L1
  • Ibuprofen (Advil, Motrin) – L1

Hemorrhoid Care

  • Topical Hydrocortisone Cream or Ointment – L2
  • Witch Hazel (Tucks Pads) – L3
  • Preparation H – (Active ingredients – mineral oil L3, petrolatum L2, and phenylephrine L3).
  • Anusol – L2

Stomach Remedies

  • Antacids:
    • Calcium carbonate (Tums) – L3
    • Magnesium hydroxide (Milk of Magnesia) – L1
  • H2 Blockers:
    • Famotidine (Pepcid) – L2

Anti-Diarrheal

*Call before taking to assess medical condition.

  • Loperamide (Imodium) – L2
  • Bismuth subsalicylate (Pepto-Bismol) – L3

Fiber Supplements

  • Psyllium Fiber (Metamucil) – L2 (Limited Data-Probably Compatible)
  • Methylcellulose (Citrucel) – L1
  • Wheat dextrin (Benefiber) – L3

Gas Relief

  • Simethicone (Gas-X, Mylicon) – L3

Nausea/Vomiting

  • Doxylamine (Unisom) + Vitamin B6 (Pyridoxine) – L3-L2
  • Ginger (capsules or tea) – L3

Stool Softeners

  • Docusate Sodium (Colace) – L2
  • Polyethylene Glycol (Miralax) – L3

Vaginal Yeast Infection

  • Topical Antifungals:
    • Clotrimazole (Lotrimin, Mycelex) – L2
    • Miconazole (Monistat) – L2
    • Terbinafine (Lamisil) – L3

Data Sources:

  • Thomas Hale, Ph.D., R.N. (2025). Medications and Mothers’ Milk.
  • LactMed Database, U.S. National Library of Medicine.

These classifications are general, but always consult your healthcare provider for individual recommendations, especially if you have specific health concerns or are taking other medications.