National Breastfeeding Awareness Day | If a mother catches a cold while breastfeeding, is it wrong to take medication like this?

May 20

National Breastfeeding Awareness Day

Breastfeeding Day on May 20th of each year is a holiday dedicated to all breastfeeding mothers and children. Breastfeeding can give newborn babies a sense of security and warmth, allowing them to develop better physically and mentally.
However, breastfeeding mothers are prone to colds, fevers, etc. due to their low resistance after childbirth, coupled with the busyness and fatigue of taking care of babies and breastfeeding, and they fail to get enough rest. At this time, whether to take medicine and whether taking medicine will affect the baby's health has become a headache for mothers. Recently, a new mother encountered such a problem. What is going on? Due to the hot and cold weather and fatigue, the new mother Xiaorong got the flu, and she was weak, stuffy, runny nose, sneezing, and quite uncomfortable. Because she wanted to recover quickly, Xiaorong took oseltamivir capsules (twice a day, 75mg/time) for anti-influenza virus and memin pseudoephedrine oral solution (twice a day, 10mL/time) to relieve cold symptoms. Xiaorong felt that the baby was too young and did not want to stop breastfeeding, so she took a few hours after taking the medicine and continued to breastfeed. The next day, Xiaorong felt that her illness was much better, but she did not expect the baby to cry and make a fuss and be irritable. She felt distressed and blamed herself when she looked at her child. She regretted that she should not have used the medicine and thought that breastfeeding after taking the medicine had affected the baby's health.

Risk classification of drugs during lactation Is it true that medication cannot be used during lactation? Not really. During lactation, mothers should seek timely treatment if they have symptoms, but they should not take medication without authorization. They should be treated reasonably and safely under the guidance of a doctor. Clinically, the risk classification of drugs during lactation is usually used to select medications. This is the "L classification" proposed by Hale, a professor of pediatrics in the United States. It is generally believed that L1 and L2 drugs do not affect breastfeeding, L3 drugs need to be used under the guidance of a clinician, and L4 and L5 drugs are prohibited during lactation. If medication is really necessary, breastfeeding should be stopped. Therefore, if breastfeeding mothers must take medication, they should try to choose relatively safe L1 and L2 grade drugs.
Oseltamivir is safe to take. The oseltamivir capsules Xiaorong took belong to the L2 classification and will be converted into active metabolites after entering the body. Studies have shown that the maximum breast milk concentration of oseltamivir occurs 3 to 4 hours after taking the medicine, and the maximum breast milk concentration of its active metabolites occurs 18 to 19 hours after taking the medicine. The half-life of oseltamivir in breast milk is about 4 hours. After 24 hours of administration, a small amount of active metabolites can still be detected in breast milk, but the concentration is very low, and the possibility of adverse effects on babies over 2 months old is very small. Therefore, oseltamivir is safe to take. If the mother is still worried, she can avoid breastfeeding 3 to 4 hours and 18 to 19 hours after taking the medicine, and pay attention to observe whether the baby has gastrointestinal discomfort. Compound preparations should be selected based on the ingredients. The Meimin pseudoephedrine oral solution Xiaorong took is a compound preparation. Each milliliter contains 2 mg of dextromethorphan, 0.4 mg of chlorpheniramine maleate (chlorpheniramine), and 6 mg of pseudoephedrine, which are used to relieve symptoms such as cough, sneezing, runny nose, and nasal congestion. These three ingredients are all L3 graded drugs.

Dextromethorphan is a centrally acting antitussive drug with a small molecular weight and is easily secreted through breast milk. Therefore, for mothers who do not have a cough, it should be used with caution during breastfeeding. For mothers with cough symptoms, normal doses of dextromethorphan can be taken during breastfeeding, but alcohol should be avoided during the medication period.

Taking a small dose of chlorpheniramine occasionally will not have much effect on the baby. However, taking a large dose for a long time may cause side effects such as decreased appetite and drowsiness in the baby. At the same time, it may also inhibit the mother's lactation. If you really need to use this type of medicine, try to take it after the last breastfeeding before bedtime to extend the time interval between the next breastfeeding and reduce the impact on the baby.
The main function of pseudoephedrine is to constrict the blood vessels of the upper respiratory tract and eliminate the congestion of the nasopharyngeal mucosa. It has little effect on the blood vessels of the whole body, but it may cause mild central excitement in highly sensitive patients, such as insomnia, headache, increased heart rate, and increased blood pressure. Therefore, breastfeeding women should try to avoid using pseudoephedrine. Some studies have speculated that if the amount of pseudoephedrine ingested by infants from breast milk is about 124μg/kg per day, the drug will not be detected in breast milk 48 hours after taking the medicine. There are also reports that 20% of babies who come into contact with breast milk containing pseudoephedrine will experience irritability, restlessness, etc., and some breastfeeding women may have reduced milk production after taking the medicine. It can be seen that pseudoephedrine may be the culprit that caused Xiaorong's baby to cry. Many cold medicines are compound preparations containing pseudoephedrine, chlorpheniramine, etc., and should be used with caution. For questions about the use of drugs, you can consult a doctor or pharmacist.

Gold and silver water are not as good as mother's milk. Breast milk is the most ideal food for babies. It is not that breastfeeding mothers cannot take medicine when they are sick, but they must read the drug instructions carefully when taking medicine to see the name of the ingredients, dosage and contraindications of the medicine. Choose medicine as needed during breastfeeding, and try not to use it if possible. If you really need to take medicine, single-ingredient preparations are the first choice. There must be an interval between taking medicines, and breast milk cannot be fed immediately. If you are not sure, ask a doctor. Safe medication is the most important thing.