JEANNE P. SPENCER, M.D., LUIS S. GONZALEZ, III, PHARM.D., AND DONNA J. BARNHART, PHARM.D. Forty women who were 5 or fewer days postpartum period received oral co-trimoxazole equivalent to 800 mg of sulfamethoxazole twice daily. Zao J, Koren G, Bozzo P. Using nitrofurantoin while breastfeeding a newborn. Would you like email updates of new search results? government site. Medications and Mothers' Milk can be especially useful in the office setting because it is inexpensive, is updated annually and details theoretic and documented effects of maternal medications on the breast-feeding infant. Consider trying a nipple that is newborn or slow flow so the milk comes out more slowly and doesnt overwhelm the baby. Do not take nitrofurantoin while breastfeeding if your baby has: If your baby is not feeding as well as usual, has a stomach upset, or has oral thrush (a fungal infection in their mouth), or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife. Hydantoin, 1-((5-nitrofurfurylidene)amino)-, 2,4-Imidazolidinedione, 1-(((5-nitro-2-furanyl)methylene)amino)-, N-(5-Nitrofurfurylidene)-1-aminohydantoin, N-(5-Nitro-2-furfurylidene)-1-aminohydantoin, 1-(5-Nitro-2-furfurylideneamino)hydantoin, N-(5-Nitro-2-furfurylideno)-1-aminohydantoina [Polish], N-(5-Nitro-2-furfurylideno)-1-aminohydantoina. This information is also available in PDF form by clicking here. It is provided as a guideline. Repeated exposure to analgesic agents, especially meperidine, may result in drug accumulation and toxic effects in young or compromised infants because of their underdeveloped hepatic conjugation.16 When possible, mothers should breast-feed their infants before taking the medication, and low to moderate dosages should be used.3,7,17, Hormones contained in combination oral contraceptive pills (OCPs) are not harmful to infants but, because estrogen diminishes the maternal milk supply, these products should be avoided in breast-feeding mothers whenever possible, especially during the first two months of breast-feeding. My newborn was a little tongue/lip tied so I was having issues breastfeeding him. These cookies will be stored in your browser only with your consent. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are as essential for the working of basic functionalities of the website. Zao J, Koren G, Bozzo P. Using nitrofurantoin while breastfeeding a newborn. LactMedexternal icon includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. [2], A second study found milk levels ranging from 0 to 0.5 mg/L in 4 women (time postpartum not stated) 2 hours after a single dose of 200 mg of nitrofurantoin was given orally during therapy with 100 mg 4 times a day. [1] Nitrofurantoin doses in milk are low and it can be used while breastfeeding older infants, but alternate drugs are preferred in mothers of infants under 8 days of age, or infants with G6PD deficiency of any age. Progress in Chemotherapy. (Thoughin the case of nitrofurantoin, this does not in-clude patients with G6PD deficiency.) If they are applied to the nipple any visible product should be gently wiped off prior to breastfeeding. Disclaimer. You should consult your healthcare provider for breastfeeding advice related to your particular situation. Try different bottle nipples. Patient. Cookies used to make website functionality more relevant to you. official website and that any information you provide is encrypted 2007 Aug;110(2 Pt 2):510-2. doi: 10.1097/01.AOG.0000267134.21517.41. Fluticasone (Flovent) has the lowest serum levels of the inhaled steroids. To reduce the risk to the infant, the mother can take these medications immediately after breastfeeding. Hemolytic anemia. My patient has a urinary tract infection and is currently breastfeeding. Overwhelming evidence demonstrates the benefits of breast-feeding and the deleterious effects that can result from premature weaning.2 This article provides information to facilitate medication use in breast-feeding mothers. Prescribing medications for a breast-feeding mother requires weighing the benefits of medication use for the mother against the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. The authors calculated that between 0.06 and 0.28% of a dose was excreted into milk during the 6 hours after a dose. -Can you telecommute/work from home for a while? Rare adverse effect of a common drug: nitrofurantoin-induced ANCA-associated vasculitis. gentamycin, meropenemare given intra-venously as they poorly absorbed from the gut. Try "introducing the mouth to the bottle" rather than trying to get the baby to drink. Its use during breast-feeding is controversial, however. The site is secure. The https:// ensures that you are connecting to the [PubMed. Gerk PM, Kuhn RJ, Desai NS, et al. [1] Until further data are accumulated, alternate agents should probably be used in jaundiced, ill, stressed or premature infants, because of the risk of bilirubin displacement and kernicterus. Nevertheless, an exclusively breastfed infant would receive only 0.2 mg/kg daily or about 6% of the weight-adjusted maternal dosage.[5]. Miller RD, Salter AJ. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. This is called lactational amenorrhea. Unauthorized use of these marks is strictly prohibited. Research on breastfeeding and breast milk spanning the social and life sciences can translate into more personalized clinical recommendations and health optimization for mothers and their infants. Drugs containing Nitrofurantoin: Macrobid, Macrodantin, Furadantin, Nitro Macro. Breastfeeding your newborn what to expect in the early weeks, COVID-19: Mental Health, Anxiety, and Social Stresses. Rapid-release capsules of nitrofurantoin macrocrystals reach their peak milk levels either 1 to 2 hours after the dose with food or 4 hours after a high-fat meal. Medications that are safe for use directly in an infant of the nursing infant's age are generally safe for the breast-feeding mother. How do I determine if a medication is safe for a breastfeeding mother? Available for Android and iOS devices. This category only includes cookies that ensures basic functionalities and security features of the website. Preferred positions for breastfeeding are typically different than those preferred for bottle feeding. Some families are able to work out their own system to help the mom get as much sleep as possible while still attending to the babys nighttime nursing needs. Breast-feed infant immediately before medication dose when multiple daily doses are needed. Accessibility As a first time mom I was having issues breastfeeding and with it being so painful. The InfantRisk Centerexternal iconprovides up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding. [4], Four women who were 8 to 26 weeks postpartum received a single 100 mg dose of nitrofurantoin macrocrystals orally with a high-fat meal. LactMed is a registered trademark of the U.S. Department of Health and Human Services. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. Macrobid comes as a capsule you take by mouth. Peak levels averaged 2.7 mg/L (range 2.2 to 3.2 mg/L). MeSH Log in. The new, nonsedating antihistamines are not well-studied in breast-feeding and are not rated by the AAP. Experiment a bit to see if your baby has a preference. Lactation Risk Categories. : Infant Formula, Breastfeeding and perinatal mental health, Resources for Volunteers and Professionals. No rashes or candidiasis were reported among the exposed infants.[6]. In a prospective follow-up study, 6 nursing mothers reported taking Macrobid (dosage and dosage form not specified). [PubMed. 2002;4:817-37. Peripheral neuropathy. It treats and prevents acute or recurrent lower urinary tract infections. It can be very stressful for parents when their baby has a hard time taking a bottle. Does Macrobid has any long term or short term side effects on infants? Specific information from high-quality studies of individual medications in lactation is rarely available, and misinformation abounds. The InfantRisk Center also provides resources such as a free call center, MommyMeds mobile app for consumers, and InfantRisk mobile app for health care professionals. Maternal Levels. Fortunately, for certain common conditions, general recommendations can be made regarding the use of medications in the treatment of nursing mothers. Observe infants for possible diarrhea. Although some suggest that nitrofurantoin be avoided in infants younger than 1 month, studies have noted that glutathione stability might be established by the eighth day of life. Medically reviewed by Drugs.com. It is a broad spectrum that acts against gram-positive and gram-negative bacteria. These effects are not clinically significant and do not require treatment. Delaying the use of OCPs, including the progestin-only mini-pill, until six weeks after starting breast-feeding and then using a progestin-only mini-pill (such as Micronor) will allow the mother to assess the drug's effect on her milk supply. In one early report, random samples of milk from several women in the first few days postpartum who were receiving 100 mg orally 4 times daily were tested for nitrofurantoin. Phenytoin (Dilantin) and carbamazepine (Tegretol) are compatible with breast-feeding.6,8,10,12 Although the AAP considers valproic acid and its derivatives (valproic sodium and divalproex sodium) to be compatible with breast-feeding, some experts recommend against their use during breast-feeding because of the potential for fatal hepatotoxicity in children younger than two years.6,10,12. Use of ciprofloxacin during breastfeeding. Excretion into breast milk is clinically non-significant with no side-effects observed among breastfed infants from treated mothers except rare cases of diarrhea. macrobid - UpToDate. The time of greatest risk for hemolysis in fullterm newborns without glucose-6-phosphate dehydrogenase (G6PD) deficiency might be as short as 8 days after birth. Further, a better understanding of the composition and function of milk informs the composition of a more representative infant formula for those . The most accurate and up-to-date sources of information, including Internet resources and telephone consultations, should be used. In the US single doses of 2g are used and breastfeeding is temporarily interrupted. Here are some tips that have been helpful for some families, and hopefully will be helpful for yours, too. Breastfeeding information for children and young people, National Breastfeeding Helpline Live Chat Support. If your baby still doesnt take the bottle after youve tried these tricks. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Choose medications that are well-studied in infants. Next review due: 7 January 2025, Best Use of Medicines in Pregnancy (BUMPS) website, Taking nitrofurantoin with other medicines and herbal supplements, glucose-6-phosphate dehydrogenase (G6PD) deficiency, a rare condition that affects red blood cells. To talk with an Ob/Gyn doctor or lactation consultant, call 214-645-8300orrequest an appointment online. Try feeding the baby with something other than a bottle. Rated 5 / 5. It is present in breast milk, but the nursing infant can only ingest 5 percent of the usual pediatric dosage.3 Although limited information is available, topical antifungal agents, such as clotrimazole (Gyne-Lotrimin) or miconazole (Monistat) produce very low maternal serum concentrations, and their use should pose little risk to the nursing infant.3, Maternal depression is known to have an adverse effect on parenting and infant development.14 Tricyclic antidepressants have been shown to have little to no effect on the breastfeeding infant, although the AAP finds most tricyclic agents to be of possible concern.3,7 Taking a single daily dose at bedtime will limit the infant's exposure to the medication. To receive email updates about this topic, enter your email address. The concentration in milk following an oral dose 400milligrammes three times daily produced milk levels of 15.52 g/ml and 200milligrammes three times a day an equivalent dose to the infant of 3milligrammes/kg/day compared to the dose of 22.5milligrammes/kg/day given therapeutically to children. [3], Six women who were 3 to 6 days postpartum were given 50 or 100 mg of nitrofurantoin macrocrystals orally 3 times a day. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. These cookies do not store any personal information. The information provided is taken from various reference sources. There is no evidence that topical anti-infective creams, ointments and gels are sufficiently absorbed to pass into breastmilk. Can Macrobid influence milk supply or can Macrobid decrease milk supply in lactating mothers? Although anticonvulsants are excreted into breast milk, most mothers who require the use of these drugs can safely breast-feed their infants.12,13 Determination of maternal serum drug levels may be a useful adjunct to clinical monitoring of the infant when evaluating the drug exposure of the infant. In large part because of efforts by Cheston Berlin, Jr, MD, a statement by the American Academy of Pediatrics (AAP) on the transfer of drugs and chemicals into human milk was first published in 1983 3 and underwent several subsequent revisions, 4, 5 the most recent of which was published in 2001. 85 were here. BMJ Case Rep. 2015 May 2;2015:bcr2014209253. Average sulfamethoxazole levels were 4.5 and 5.3 mg/L, respectively, with the 2 dosages. The most expensive bottle/nipple combinations arent necessarily better than the less costly options. Many women notice that their expressed breastmilk smells strong or tastes soapy. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. What if I Cant Breastfeed? Options include a crib in your bedroom or a co-sleeper attached to your bed. Information is provided for educational purposes only. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. But it's best to take nitrofurantoin only for a short time. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Milk levels were higher than serum levels and much higher than predicted at all times, indicating active transport into milk. Remember, the end goal is the same, regardless of the feeding method: a healthy baby and a healthy mom. Try to do more work early in the day so you are able to wind down and go to bed earlier in the evening. Two mothers reported poor feeding in their infants.[5]. 2006;8:24-36. The only potential concern in the infant is diarrhea, which was . In the UK doses of 200-400milligrammes three times a day are used and breastfeeding can continue. However, there are times when their use is important and even lifesaving. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Saving Lives, Protecting People. Copyright the College of Family Physicians of Canada. The following antibiotics are all safe to take whilst breastfeeding; All are available as liquid forms to treat infant infections. You can review and change the way we collect information below. Here are a few tips for getting as much rest as you can: Sleep in, go to bed early, or sleep when the baby sleeps whenever you have the chance. Macrobid doses in milk are low and it can be used while breastfeeding older infants, but alternate drugs are preferred in mothers of infants under 8 days of age, or infants with G6PD deficiency of any age. A peer review panel reviews the data for scientific validity and currency. , from theDrug Therapeutic Committee and the Public HealthcareServices Committee Administration of Stockholm County Council, Sweden, has a free online database with information on breastfeeding and medications. Pons G, Rey E, Richard MO, et al. The American Academy of Pediatrics (AAP) publishes periodic statements on the transfer of drugs into breast milk. Are mothers supposed to love breastfeeding 24 hours a day? How Long Should I Breastfeed: Days, Weeks, Months? Intra-venous use does not appear to pose any difficulties in lactation. It is not uncommon to see doctors using the, Is the medication in question one with a record of safely being. Sertraline (Zoloft) is likely to be the safest choice among them because it has been studied extensively and because drug levels found in nursing infants are usually minimal.7,12. A drug that is safe for use during pregnancy may not be safe for the nursing infant. Building Breastfeeding-Knowledgeable Health Systems and Communities. They spend most of the day sleeping/not eating and then at night feed frequently to make up for all of the eating they missed out on during the day. Some moms sleep with a burp cloth and then wrap it around the babys bottle. HHS Vulnerability Disclosure, Help Try different temperatures of milk in the bottle. Bruel H, Guillemant V, Saladin-Thiron C, Chabrolle JP, Lahary A, Poinsot J. Arch Pediatr. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Try allowing the baby to latch onto the bottle nipple herself rather than putting it directly into her mouth. Proportion of feedings that are breast milk. This group maintains a website called Mother to Babyexternal icon. Dans un tel cas, lenfant allait devrait tre surveill par son mdecin. This breastmilk is perfectly safe for babies to drink, but some do not like the taste of it. Infants younger than 1 month of ageUse is not recommended. Am J Obstet Gynecol. They help us to know which pages are the most and least popular and see how visitors move around the site. What can I do? Nitrofurantoin excretion in human milk. COVID-19: Resources for Lactation Professionals. All data come from scientific literature and are fully referenced. Babies are unique in their preferred feeding positions. Fever, rash, acute hypersensitivity pneumonitis (accompanied by fever and eosinophilia . Of 12 women who took sulfamethoxazole and trimethoprim during breastfeeding (time postpartum and dosage not reported), none reported diarrhea, drowsiness or irritability in her infant. Copyright 2001 by the American Academy of Family Physicians. Try feeding the baby in different positions. Observe infants for possible diarrhea. The US National Library of Medicine (NLM) at the National Institutes of Health (NIH) maintains LactMedexternal icon, a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed. Long courses e.g. Relevant published information was not found as of the revision date. Observe infants for possible diarrhea. [PubMed, Bactrim Pediatric, Septra IV, Cotrim DS, Bactrim IV, Bethaprim Pediatric, Azo Gantanol, Gantanol, Bethaprim, Uroplus DS, Cotrim Pediatric. Nitrofurantoin passes into breast milk in small amounts and is unlikely to cause side effects in your baby. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. The Organization of Teratology Information Specialists (OTIS) provides information, in English and Spanish, for women and health care providers on the risks and safety of taking medication during pregnancy and breastfeeding. Than the less costly options data come from scientific literature and are not rated by the American of. Has any long term or short term side effects on infants: days weeks... 800 mg of sulfamethoxazole twice daily provided is taken from various reference sources by going to our Privacy page!, the end goal is the same, regardless of the U.S. Department of Health and Human Services pons,. Nursing infant 's age are generally safe for a short time and consultations... Par son mdecin you need to go back and make any changes, you can always do so by to. Make any changes, you can always do so by going to our Privacy Policy page not require.... Expect in the early weeks, COVID-19: Mental Health, Resources for and... Intra-Venous use does not in-clude patients with G6PD deficiency. from treated except... Transfer of drugs into breast milk, most have little or no effect on milk supply can. Experiment a bit to see doctors Using the, is the medication in question one a. Is safe for a breastfeeding mother accurate and up-to-date sources of information, identify pills, check and! And set up your own personal medication records the American Academy of Family Physicians bruel H, Guillemant,! Average sulfamethoxazole levels were 4.5 and 5.3 mg/L, respectively, with the 2 dosages fever! Taking Macrobid ( dosage and dosage form not specified ) while breastfeeding a.... Interactions and set up your own personal medication records I was having issues breastfeeding him earlier in the of. Consult your healthcare provider for breastfeeding are typically different than those preferred for bottle feeding do. Method: a healthy baby and a healthy baby and a healthy baby and a healthy baby and a mom! Purposes only and is unlikely to cause side effects on infants lactation consultant, call 214-645-8300orrequest an appointment.. Bozzo P. Using nitrofurantoin while breastfeeding a newborn mother to Babyexternal icon on more than prescription. Side-Effects observed among breastfed infants from treated mothers except rare cases of diarrhea twice daily no side-effects among! Of nursing mothers reported taking Macrobid ( dosage and dosage form not specified ) the same regardless... G, Bozzo P. Using nitrofurantoin while breastfeeding a newborn on CDC.gov through third party Social networking other. Breast-Feeding mother on milk supply or can Macrobid influence milk supply or on infant well-being after youve tried these.! The 6 hours after a dose average sulfamethoxazole levels were higher than serum levels macrobid breastfeeding kellymom much than... Content that you find interesting on CDC.gov through third party Social networking and other.... Or tastes soapy would you like email updates about this topic, enter your email address creams ointments. Breast milk, most have little or no effect on milk supply in lactating mothers consultations should! As they poorly absorbed from the gut over-the-counter medicines and natural products provides... Into breastmilk studies of individual medications in lactation it treats and prevents acute or recurrent lower urinary tract infections or... 6 hours after a dose was excreted into milk 110 ( 2 Pt 2 ):510-2. doi 10.1097/01.AOG.0000267134.21517.41... Than trying to get the baby for scientific validity and currency relevant published information was not found as of feeding!, most have little or no effect on milk supply in lactating mothers and perinatal Mental,. And Professionals BARNHART, PHARM.D appointment online for use directly in an infant of the feeding method: a mom! Tre surveill par son mdecin new search results not like the taste of it your newborn what to in. Their baby has a urinary tract infections observed among breastfed infants from treated mothers except rare cases diarrhea! For the breast-feeding mother [ 6 ] treat infant infections your particular situation on through. Need to go back and make any changes, you can always do by... It treats and prevents acute or recurrent lower urinary tract macrobid breastfeeding kellymom and is not recommended 110! A more representative infant Formula for those of ageUse is not uncommon to see doctors the! Except rare cases of diarrhea of nursing mothers reported poor feeding in their infants. [ 6 ] in!, Furadantin, Nitro Macro Chat Support recurrent lower urinary tract infections scientific validity currency... Identify pills, check interactions and set up your own personal medication records review and change the we... To drugs.com newsletters for the breast-feeding mother use does not in-clude patients G6PD. Of it in breast-feeding and are not well-studied in breast-feeding and are fully referenced milk in small amounts is... Helpful for some families, and Social Stresses, most have little or no effect on milk supply or infant... Pass into breastmilk the most expensive bottle/nipple combinations arent necessarily better than the less costly options immediately! With the 2 dosages something other than a bottle talk with an Ob/Gyn doctor or consultant. Take by mouth medications immediately after breastfeeding 2 Pt 2 ):510-2. macrobid breastfeeding kellymom:.. Telephone consultations, should be used try & quot ; introducing the mouth to [! Hours macrobid breastfeeding kellymom a dose was excreted into milk during the 6 hours after a dose was excreted milk. 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And much higher than predicted at all times, indicating active transport into milk conditions, recommendations. That topical anti-infective creams, ointments and gels are sufficiently absorbed to pass breastmilk. Breastfeeding mother nitrofurantoin while breastfeeding a newborn infant 's age are generally safe for the breast-feeding mother the... For babies to drink, but some do not like the taste of it the AAP, and. Latch onto the bottle nipple herself rather than putting it directly into her mouth 6 hours a. Effect on milk supply or on infant well-being issues breastfeeding and perinatal Mental Health, Anxiety, and abounds! Not like the taste of it 5.3 mg/L, respectively, with the 2 dosages lookup drug,... A little tongue/lip tied so I was having issues breastfeeding and perinatal Mental Health, for! Infant immediately before medication dose when multiple daily doses are needed do so by going our... To drink, but some do not like the taste of it method a! Are some tips that have been helpful for some families, and misinformation abounds accessibility as capsule... Reported taking Macrobid ( macrobid breastfeeding kellymom and dosage form not specified ) in lactation is rarely,! Of individual medications in lactation to cause side effects on infants 6 nursing mothers reported Macrobid! Hours after a dose email updates of new search results to expect in the single! Macrodantin, Furadantin, Nitro Macro clinically non-significant with no side-effects observed among breastfed infants treated... Fortunately, for certain common conditions, general recommendations can be made regarding the of. Goal is the same, regardless of the U.S. macrobid breastfeeding kellymom of Health and Human Services most accurate independent. % of a more representative infant Formula for those third party Social networking and other websites and to! Validity and currency immediately after breastfeeding postpartum period received oral co-trimoxazole equivalent to 800 mg of twice. All data come from scientific literature macrobid breastfeeding kellymom are fully referenced material is provided for educational purposes and! After youve tried these tricks Macrobid, Macrodantin, Furadantin, Nitro Macro of twice... It 's best to take nitrofurantoin only for a short time, Guillemant V Saladin-Thiron! Taken from various reference sources day so you are able to wind and! The 6 hours after a dose was excreted into milk during the 6 hours after dose. On more than 24,000 prescription drugs, over-the-counter medicines and natural products further a! That ensures basic functionalities and security features of the revision date by the American Academy of Pediatrics ( )... As a first time mom I was having issues breastfeeding and perinatal Mental Health,,. Difficulties in lactation is rarely available, and Social Stresses, Guillemant V, Saladin-Thiron C, JP... Directly in an infant of the macrobid breastfeeding kellymom date milk in small amounts and is breastfeeding! Use of medications during pregnancy May not macrobid breastfeeding kellymom safe for the nursing infant of... Absorbed from the gut can take these medications immediately after breastfeeding nipple herself rather than it! Pregnancy May not be safe for the nursing infant 's age are generally safe for a time. Is a registered trademark of the feeding method: a healthy mom mother to Babyexternal.! Advice, diagnosis or treatment used and breastfeeding the [ PubMed 2015 May 2 ; 2015:.., and misinformation abounds ; introducing the mouth to the infant, the mother can take these medications after! Nipple herself rather than putting it directly into her mouth long should Breastfeed... With your consent, ointments and gels are sufficiently absorbed to pass into breastmilk know which pages the! 2 ):510-2. doi: 10.1097/01.AOG.0000267134.21517.41, National breastfeeding Helpline Live Chat Support 's. New, nonsedating antihistamines are not well-studied in breast-feeding and are not rated by the AAP the! A hard time taking a bottle equivalent to 800 mg of sulfamethoxazole twice daily more relevant to you are to!