Tag Archives: what not to take when nursing

Antibiotics – Don’t Take This With That!

Antibiotics are medicines that help stop bacterial infections. Protect yourself and your family by taking them correctly. There are times when you should and when you should not take antibiotics.

In children, antibiotics are the most common cause of emergency department visits for adverse drug events. Rest, fluids, and over-the-counter products may be your or your child’s best treatment option.

And NEVER give a child under the age of 19 aspirin or aspirin containing products, as it could trigger Reye’s Syndrome, a deadly disease!

The main types of germs that cause infections:antibiotics_dttwt

Viruses and bacteria are the two main types of germs that cause infection.

Antibiotics cannot kill viruses but can kill bacteria. Viral infections should not be treated with antibiotics.

Viral illnesses include:

  • Common cold – stuffy nose, sore throat, sneezing, cough headache.
  • Influenza (flu) – fever, chills, body aches, headache, sore throat, dry cough.
  • Many coughs.
  • Acute bronchitis (cough, fever) – almost always caused by viruses.
  • Pharyngitis (sore throat) – most sore throats are caused by viruses and are not effectively treated with an antibiotic.
  • Viral gastroenteritis.

Bacterial infections should be treated with antibiotics. Bacterial infections can include:

  • Ear infections – antibiotics are used for most, but not all ear infections.
  • Severe sinus infections – lasting two or more weeks.
  • Strep throat.
  • Urinary tract infection.

Antibiotics can sometimes interact with other medicines or other substances. This means that the effects of one of the medicines can be altered by the other.

Some of the more common interactions are listed below. However, this is not a complete list.

If you want to check that your medicines are safe to take with your antibiotics, ask your GP or local pharmacist. You should also always carefully read the patient information leaflet that comes with your medicine.

Combined oral contraceptives

Antibiotics may cause your combined oral contraceptive pill to be less effective at preventing pregnancy.

Women taking combined oral contraceptives should use an extra method of contraception (for example, condoms) while taking the antibiotics and, in some cases, for seven days after finishing the course. Your GP will be able to advise you.

Medications To Avoid:


It is usually recommended that you avoid taking penicillin at the same time as a medication called methotrexate, which is used to treat some types of cancers and severe autoimmune conditions such as the skin condition psoriasis. This is because combining the two medications can cause a range of unpleasant and sometimes serious side effects.

You may experience a skin rash if you take penicillin and a medication called allopurinol, which is used to treat gout.


Cephalosporins may not be suitable to take if you are also taking blood-thinning medications such as heparin and warfarin.

If you need treatment with cephalosporins, you may temporarily have to stop taking the blood-thinning medication.


The risk of damage to your kidneys and hearing is increased if you are taking one or more of the following medications:

  • antifungals – used to treat fungal infections
  • cyclosporin – used to treat autoimmune conditions such as Crohn’s disease and given to people who have had an organ transplant
  • diuretics – used to remove water from the body
  • muscle relaxants

However, the risk of kidney and hearing damage has to be balanced against the benefits of using aminoglycosides to treat life-threatening conditions such as meningitis.


You should check with your GP or pharmacist before taking a tetracycline if you are currently taking any of the following medications:

  • vitamin A supplements
  • retinoids such as acitretin, isotretinoin and tretinoin used to treat severe acne
  • blood-thinning medication
  • diuretics
  • kaolin-pectin and bismuth subsalicylate (Pepto Bismol) used to treat diarrhea
  • medicines to treat diabetes such as insulin
  • atovaquone used to treat pneumonia
  • antacids used to treat indigestion and heartburn
  • sucralfate used to treat ulcers
  • lithium used to treat bipolar disorder and severe depression
  • digoxin to treat heart rhythm disorders
  • methotrexate
  • strontium ranelate used to treat osteoporosis
  • colestipol or colestyramine used to treat high cholesterol
  • ergotamine and methysergide used to treat migraines


It is highly recommended that you do not combine a macrolide with any of the following medications (unless directly instructed to by your GP), as the combination could cause heart problems:

  • terfenadine, astemizole and mizolastine – which are all antihistamines used to treat allergic conditions such as hay fever
  • amisulpride – used to treat episodes of psychosis
  • tolterodine – used to treat urinary incontinence
  • simvastatin – used to treat high cholesterol


You should check with your GP or pharmacist before taking a fluoroquinolone if you are currently taking any of the following medications:

  • theophylline, which is used to treat asthma and also found in some cough and cold medicines
  • the non-steroidal anti-inflammatory drug (NSAID) painkillers such as ibuprofen
  • ciclosporin
  • probenecid used to treat gout
  • clozapine used to treat schizophrenia
  • ropinirole used to treat Parkinson’s disease
  • tizanadine used to treat muscle spasms
  • glibenclamide used to treat diabetes
  • cisapride used to treat indigestion, heartburn, vomiting or nausea
  • tricyclic antidepressants, such as amitriptyline, steroid medications (corticosteroids)

Some fluoroquinolones can intensify the effects of caffeine (a stimulant found in coffee, tea and cola), which could make you feel irritable, restless and cause problems falling asleep (insomnia).

Finally, you may need to avoid taking medication that contains high levels of minerals or iron as this can block the beneficial effects of fluoroquinolones. This includes:

  • antacids
  • zinc supplements
  • some types of multivitamin supplements

Antibiotics that can cause Sun Sensitivity include:  Doxycycline, tetracycline, ciprofloxacin, ofloxacin, levofloxacin, trimethoprim. In some people, the sensitivity can last long after the antibiotic regimine is complete.

Phototoxicity. This is the most common type of sun-sensitivity drug reaction. It can occur when skin is exposed to the sun after certain medications are injected, taken orally, or applied to the skin. The drug absorbs the UV light, then releases it into the skin, causing cell death. Within a few days, symptoms appear on the exposed areas of the body. In some people, symptoms can persist up to 20 years after the medication is stopped. Among the most common phototoxic drugs are the tetracycline family, NSAIDs (nonsteroidal anti-inflammatory drugs such as ibuprofen), and amiodarone (Cordarone, a heart medication).

It’s important to note that not every person who uses these drugs has a reaction. If it does happen, it can be a one-time occurrence, or it can happen each time the drug is taken and sun exposure occurs. People with HIV are among the most likely group to experience sun sensitivity to drugs.

Can I drink alcohol when on an antibiotic?

Alcohol is a drug and in combination with other drugs including antibiotics, can cause an interaction with undesirable results. Ask your doctor about your specific medication, but in general, you should avoid combining alcohol with any medication.

A list of ingredients to avoid, (other names for aspirin) can be downloaded here, or you can email the NRSF for a wallet size card(s) you can carry with you when shopping for medications.

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Breastfeeding and Drugs: Drugs Deemed Not Safe

Information about what drugs are NOT safe to use during breastfeeding.

A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her breastfeedingphysician to stop nursing.  Of course, if you don’t have to take drugs, whether they are over the counter, or prescription, it is always for the best.

This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacological treatment of breastfeeding mothers.

Below is a list of drugs deemed NOT safe to take by the American Academy of Pediatrics.

Cytotoxic Drugs That May Interfere With Cellular Metabolism of the Nursing Infant:

Cyclophosphamide  — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
Cyclosporine —  Possible immune suppression; unknown effect on growth or association with carcinogenesis
Doxorubicin* — Possible immune suppression; unknown effect on growth or association with carcinogenesis
Methotrexate — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
* Drug is concentrated in human milk.

Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported*

Amphetamine† — Irritability, poor sleeping pattern
Cocaine — Cocaine intoxication: — irritability, vomiting, diarrhea, tremulousness, seizures
Heroin — Tremors, restlessness, vomiting, poor feeding
Marijuana — Only 1 report in literature; no effect mentioned; very long –half-life for some components
Phencyclidine — Potent hallucinogen
* The Committee on Drugs strongly believes that nursing mothers should not ingest drugs of abuse, because they are hazardous to the nursing infant and to the health of the mother.
† Drug is concentrated in human milk.

Radioactive Compounds That Require Temporary Cessation of Breastfeeding*

Copper 64 (64Cu) — Radioactivity in milk present at 50 h
Gallium 67 (67Ga) — Radioactivity in milk present for 2 wk
Indium 111 (111In) — Very small amount present at 20 h
Iodine 123 (123I) — Radioactivity in milk present up to 36 h
Iodine 125 (125I) — Radioactivity in milk present for 12 d 42
Iodine 131 (131I) —  Radioactivity in milk present 2–14 d, depending on study
Iodine131 — If used for treatment of thyroid cancer, high radioactivity may prolong exposure to infant
Radioactive sodium — Radioactivity in milk present 96 h
Technetium 99m (99mTc), 99mTc
macroaggregates, 99mTc O4 — Radioactivity in milk present 15 h to 3 d
* Consult nuclear medicine physician before performing diagnostic study so that radionuclide that has the shortest excretion time in breast milk can be used. Before study, the mother should pump her breast and store enough milk in the freezer for feeding the infant; after study, the mother should pump her breast to maintain milk production but discard all milk pumped for the required time that radioactivity is present in milk. Milk samples can be screened by radiology departments for radioactivity before resumption of nursing.

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*

Fluoxetine — Colic, irritability, feeding and sleep disorders, slow weight gain
Chlorpromazine — Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores
Haloperidol — Decline in developmental scores
Amiodarone — Possible hypothyroidism
Chloramphenicol — Possible idiosyncratic bone marrow suppression
Clofazimine — Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation
Lamotrigine —  Potential therapeutic serum concentrations in infant
Metoclopramide† — dopaminergic blocking agent
Metronidazole — In vitro mutagen; may discontinue breastfeeding for 12–24 h to allow excretion of dose when single-dose therapy given to mother
Tinidazole  — See metronidazole
* Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.
† Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.

Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers With Caution*

Acebutolol — Hypotension; bradycardia; tachypnea
5-Aminosalicylic acid — Diarrhea (1 case) ,  Aspirin; Reye’s Syndrome
Atenolol — Cyanosis; bradycardia
Bromocriptine — Suppresses lactation; may be hazardous to the mother
Aspirin — (salicylates) Metabolic acidosis (1 case),  Reye’s Syndrome
Clemastine — Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness (1 case)
Ergotamine — Vomiting, diarrhea, convulsions (doses used in migraine medications)
Lithium — One-third to one-half therapeutic blood concentration in infants
Phenindione — Anticoagulant: increased prothrombin and partial thromboplastin time in 1 infant; not used in United States
Phenobarbital — Sedation; infantile spasms after weaning from milk containing phenobarbital, methemoglobinemia (1 case)
Primidone — Sedation, feeding problems
Sulfasalazine (salicylazosulfapyridine) — Bloody diarrhea (1 case), Reye’s Syndrome
* Blood concentration in the infant may be of clinical importance



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