General considerations
It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.
Recommendations
Hyoscine butylbromide, propantheline or peppermint oil are considered preferred choices in breastfeeding.
Mebeverine and alverine can also be used.
There is limited evidence for the use of antispasmodics during breastfeeding and therefore recommendations are generally made on the properties of the medicine. The choice of medicine will depend on symptoms.
Breast milk supply
There is a theoretical risk that suppression of breast milk production could occur with antimuscarinic drugs (atropine, hyoscine butylbromide, propantheline). There have also been conflicting reports that peppermint may increase or decrease breast milk production. There is no published evidence to support this.
Once breastfeeding is established, any effect on breast milk production becomes less significant.
It is therefore advisable to monitor breastfed infants for adequate feeding and poor weight gain, especially if used long-term.
Specific recommendations
Patient Information
The NHS website provides advice for patients on the use of specific medicines in breastfeeding.
Contact us
Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:
- you need further advice
- the medicine in question is not included here
- the infant is unwell or premature
- multiple medicines are being taken
About our recommendations
Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.
If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.
Bibliography
Full referencing is available on request.