Using laxatives during lactation

Using laxatives during breastfeeding

• any laxative can be used during breastfeeding as most are either not absorbed or minimally absorbed from the gastrointestinal tract leading to low or negligible levels in breast milk
• prucalopride can be used with caution whilst breastfeeding as it is excreted into breast milk in small levels
  • prucalopride is a selective serotonin 5HT4-receptor agonist which is used for chronic constipation where other laxatives have failed.
  • other laxatives are preferable but, given its place in therapy, may already have been tried
• lifestyle interventions such as increased dietary fibre and exercise should always be tried first
  • maintaining fluid intake will also help with milk supply
  • if a laxative is needed, always use the lowest dose for the shortest time possible
• are three main types of laxatives - bulk-forming, osmotic or stimulant
  • treatment choice should be primarily based on clinical indications, with suitability in breastfeeding as a secondary consideration
  • in some cases, constipation may be a sign of dehydration
  • drinking fluids is important to maintain sufficient breast milk supply in addition to helping relieve constipation
  • bulk-forming laxatives
    • ispaghula husk can be used during breastfeeding
    • infant monitoring
      • no specific infant monitoring is usually required
      • monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine
      • is no evidence for use in breastfeeding, ispaghula husk is not absorbed by the body and will not appear in breast milk. Infant side effects are therefore not expected
      • ispaghula husk can be used in infants over 1 month old. Doses used will be much higher than the amounts the infant may be exposed to via breast milk
  • osmotic laxatives
    • lactulose can be used during breastfeeding
      • infant monitoring
        • as a precaution monitor the infant for diarrhoea, vomiting or irritability.
        • monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine
        • is no evidence for use in breastfeeding, its very low oral bioavailability makes passage into breast milk highly unlikely. Infant side effects are therefore not expected
        • lactulose can be used in infants over 1 month old. Doses used will be much higher than the amounts the infant may be exposed to via breast milk
    • macrogol 3350 can be used during breastfeeding
      • infant monitoring
        • as a precaution monitor the infant for diarrhoea, vomiting or irritability
        • monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine
        • is no evidence for use in breastfeeding, its negligible oral bioavailability and high molecular weight will limit passage into breast milk and absorption by the infant. Infant side effects are therefore not expected
  • stimulant laxatives
    • standardised senna preparations can be used during breastfeeding
      • infant monitoring
        • as a precaution monitor the infant for diarrhoea or irritability
        • monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine
        • limited published evidence has shown negligible amounts in breast milk, due to its poor oral absorption and high molecular weight. No side effects have been reported in breastfed infants
        • non-standardised senna preparations are available to purchase as herbal or alternative products. The ingredients or potency in these products may vary and patients should be advised that standardised products should be used
        • senna can be used in infants over 1 month old. Doses used will be much higher than the amounts the infant may be exposed to via breast milk
  • glycerol suppositories can be used during breastfeeding
    • infant monitoring
      • no specific infant monitoring is usually required
      • monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine
      • is no evidence for use in breastfeeding, its negligible rectal bioavailability will limit passage into breast milk
      • glycerol is found naturally in breast milk, and infant side effects are therefore not expected
      • glycerol suppositories can be used in infants. Doses used will be much higher than the amounts the infant may be exposed to via breast milk

For more detailed guidance then see using laxatives during breastfeeding

Consult the respective summary of product characteristics (SPC) before prescribing laxatives during breastfeeding.

Reference:

1. NHS Specialist Pharmacy Service (October 2023). Using laxatives during breastfeeding