Patient's question:
Oral intake of drugs such as vitamin C to inhibit melanin production, along with topical application of 3% hydroquinone cream or hydrogen peroxide, can be temporarily effective. Alternatively, applying 3% lactic acid once daily until scaling subsides is also recommended.Can these be used during breastfeeding?
Doctor's answer:
Principles for Drug Selection During Lactation1. Although medication is possible during lactation, the general principle remains: Avoid medication whenever possible for conditions that do not require it; prefer oral administration over intravenous injections; if medication is necessary, use the lowest effective dose with the shortest possible duration; and closely monitor for adverse reactions during treatment.
2. Prefer single-ingredient, short-acting, and rapid-release medications while avoiding long-acting drugs or the use of multiple medications simultaneously. In other words, avoid medications labeled with terms like "compound"; for the same drug, opt for those requiring three to four doses per day instead of once-daily extended-release tablets.
3. Choose medications that minimally enter breast milk and have clinical evidence proving no significant harm to the infant.
4. Prioritize topical medications. For areas the baby may contact, such as cracked nipples, apply the medication after each feeding and thoroughly clean it before the next feeding.
5. Use traditional Chinese medicine (TCM) and tonics with caution. Many new mothers, experiencing postpartum "Qi and blood deficiency," may use TCM to nourish yin, invigorate blood, and remove stagnation. However, many TCM ingredients have limited research on their composition and toxicity, and some commonly used herbs may be hepatotoxic or nephrotoxic, with uncertain transfer into breast milk. Some TCM herbs have a milk-suppressing effect, such as rhubarb, roasted malt, Xiao Yao San (Free and Easy Wanderer), and mint.
6. Take medication immediately after breastfeeding and delay the next feeding as much as possible, ensuring at least a 4-hour interval. This allows more time for the drug to metabolize and excrete in the mother’s body, reducing the drug concentration in breast milk. Adjusting medication timing in this way minimizes the amount of drug absorbed by the infant.
7. Breastfeeding mothers should closely monitor their babies’ reactions if they take medication, especially when using drugs with caution. Early detection of adverse drug reactions allows for prompt discontinuation or switching to alternative medications. For example, breastfeeding mothers taking penicillin should watch for rashes, while those taking clindamycin should monitor for diarrhea. If adverse reactions occur, seek medical attention promptly. Since infants’ toxic reactions differ from adults’, if it is uncertain whether the baby’s symptoms are related to breast milk, breastfeeding should be temporarily suspended.