Laxatives and Breastfeeding

August 1, 2011. Posted in: Medications & Vaccines

  • References
  • Links for additional information

    • Info on selected laxatives

    Most laxatives, particularly dietary fiber/bulk forming laxatives and stool softeners, are considered compatible with breastfeeding. The stimulant laxatives are more likely to be of concern, and should never be used long-term (whether you are breastfeeding or not).

    Drug-free alternatives for treating constipation include:

    • Eat a high fiber diet – whole grains, 5+ servings of fruit/vegetables each day
    • Drink plenty of fluids
    • Don’t put off the “urge” to go

    The information summarized below is only a general overview. For detailed information on the specific drugs, please review the references listed below with your health care provider.

    In most cases, the brand names of drugs are not listed here since there are many brand names and many products contain two or more active ingredients; generic names are listed in alphabetical order – check your product information for the names of the active ingredients.

    Dietary Fiber / Bulk Forming Laxatives
    This type of laxative is not absorbed via the GI tract and thus should not pose a problem for breastfeeding mothers. Thus far none have been reviewed specifically by the AAP or “Medications and Mothers’ Milk.”
    Name
    Fructan
    Fruits & vegetables, prunes, prune juice
    Malt Soup Extract (Maltsupex)
    Psyllium seed, Psyllium Hydrophilic Mucilloid
    Synthetic dietary fibers – methylcellulose, cellulose, polycarbophil, calcium polycarbophil, carboxymethylcellulose
    Wheat or oat bran, flaxseed

     

    Stool Softeners / Emollient Laxatives
    Name of medication
    AAP approved?*
    		 Lactation Risk Category**
    Notes
    Docusate Sodium,
    Docusate Calcium
    not reviewed
    		 L2 (safer)

    *  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
    ** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

    1. Per Hale: Watch for loose stools in infant, but no concerns have been reported.

     

    Hyperosmotic Laxatives
    Name of medication
    AAP approved?*
    		 Lactation Risk Category**
    Notes
    Glycerin
    not reviewed
    		 not reviewed
    Lactulose not reviewed not reviewed 2
    Polyethylene Glycol,
    Polyethylene Glycol with Electrolytes (PEG 3350, NuLYTELY)    		 not reviewed L3 (moderately safe) 3
    Sorbitol not reviewed not reviewed 4

    *  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
    ** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

    1. Poor rectal absorption (suppository).
    2. Minimal oral absorption.
    3. Negligible absorption from gastrointestinal tract and thus, per Hale, highly unlikely to enter milk.
    4. See also Can I eat/drink foods containing artificial sweeteners?

     

    Hyperosmotic Saline Laxatives
    Poorly absorbed from the GI tract. Not recommended during pregnancy.
    Name of medication
    AAP approved?*
    		 Lactation Risk Category**
    Magnesium Citrate
    not reviewed
    		 see Magnesium Sulfate
    Magnesium Hydroxide
    (milk of magnesia)     		not reviewed L1 (safest)
    Magnesium Oxide not reviewed see Magnesium Hydroxide
    Magnesium Sulfate
    (epsom salt)    		 yes L1 (safest)
    Sodium Phosphate not reviewed not reviewed

    *  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
    ** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

     

    Lubricant Laxatives
    Name of medication
    AAP approved?*
    		 Lactation Risk Category**
    Notes
    Mineral Oil
    not reviewed
    		 not reviewed

    *  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
    ** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

    1. Minimal oral/rectal absorption. Repeated oral use of mineral oil may decrease absorption of foods, fat-soluble vitamins, and some oral medications.

     

    Stimulant / Irritant Laxatives
    This type of laxative is not safe for long-term use, as long-term use can cause permanent damage to the colon. Avoid using for more than 10 consecutive days. This is the type of laxative most likely to be of concern during lactation (see individual drug information).
    Name of medication
    AAP approved?*
    		 Lactation Risk Category**
    Notes
    Aloe, Aloe Vera not reviewed L3 (moderately safe)
    Bisacodyl not reviewed L2 (safer) 2
    Casanthranol not reviewed not reviewed  
    Cascara Sagrada yes L3 (moderately safe) 3
    Castor Oil not reviewed L3 (moderately safe) 4
    Dehydrocholic Acid not reviewed not reviewed 5
    Senna, Sennosides yes L3 (moderately safe) 6

    *  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
    ** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

    1. Internal use of aloe vera is strongly discouraged, particularly in children and pregnant or breastfeeding women. See also Aloe Vera.
    2. Minimal oral/rectal absorption.
    3. Per Hale, cascara sagrada may cause loose stools in newborns. See also Cascara sagrada.
    4. Oral absorption is unknown. Contraindicated during pregnancy due to risk of uterine contractions. Per Hale, use with caution; excess amounts could cause diarrhea, insomnia, tremors in infant.
    5. Significant oral absorption.
    6. Per Hale, may cause loose stools in infant. See also Senna.

     

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    References

    Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

    Hale, Thomas. Medications and Mothers’ Milk, 10th Edition. Pharmasoft Medical Publishing, 2002. Dr. Hale’s website is located at http://neonatal.ttuhsc.edu/lact/index.html.

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    Links for additional information

    Selected List of Medications approved by the AAP for use in breastfeeding mothers (revised 9/01) (at this website)

    Medications and Breastfeeding: References (at this website)

    Constipation from MedicineNet.com

    Laxatives (Local) monograph from drugs.com

    Laxative Products Review is a useful set of information on laxatives; just keep in mind that the website is selling a laxative alternative product.

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