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Can You Have Pepto Bismol When Breastfeeding?

Can You Have Pepto Bismol When Breastfeeding

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    Acidity (gastroesophageal reflux), and diarrhea are common ailments that could occur when you are breastfeeding. You may want to make some lifestyle and dietary changes to address the problem, but if your symptoms do not subside, then you may want to take medications such as Pepto-Bismol.

    In this post, MomJunction tells you if you can have Pepto-Bismol during pregnancy, its ingredients, and possible side effects.

    What Is Pepto-Bismol?

    Pepto-Bismol is an over-the-counter (OTC) antacid used for relief from minor gastrointestinal ailments such as heartburn, nausea, upset stomach, bloated tummy, indigestion, gas, belching, and diarrhea(1). The medicine is available in liquid, capsule, and chewable tablet form.

    What Are The Ingredients Of Pepto-Bismol?

    The active ingredient of Pepto-Bismol is a compound called bismuth subsalicylate, which plays a significant role in alleviating symptoms of gastrointestinal problems. It forms a coat (protective layer) on the ulcers and helps in the secretion of prostaglandins and mucus that reduce the effects of stomach acid (2).

    The concentration of the compound varies based on the form of medicine. The manufacturer recommends no more than eight doses in 24 hours (3).

    Is It Safe To Have Pepto-Bismol When Breastfeeding?

    The US Centers for Disease Control and Prevention recommends lactating mothers avoid bismuth subsalicylate, as it can find its way into breast milk(4).

    The Journal of Travel Medicine also recommends lactating mothers avoid medication containing bismuth subsalicylate. Though the effects on the infant are unknown, salicylate was observed to be absorbed significantly (5).

    What Are The Side Effects Of Pepto-Bismol On Breastfeeding Baby?

    The side effects of Pepto-Bismol/Bismuth subsalicylate on the health of the infant are unknown.

    But there is some research on the impact of the compound salicylate, which is also called salicylic acid. Salicylate is found in Pepto-Bismol as well as in Aspirin, whose effects on the breastfeeding baby have been widely researched(6).

    Studies suggest that less than 1% of maternal salicylic acid dosage passes into breast milk(7). According to the Drug Principles in Lactation published by The American College of Clinical Pharmacy, “Salicylates should be avoided because of the risk of thrombocytopenia and tinnitus in a nursing infant (8).”

    The compound also holds the potential to cause the following side effects among breastfeeding infants:

    1. Reye’s syndrome: Some research suggests that regular ingestion of salicylic acid by a breastfeeding baby can increase the risk of Reye’s syndrome(9)(10). Reye’s syndrome is an incurable, mostly pediatric condition, which primarily affects the brain and the liver. It causes increased pressure within the brain and the accumulation of fat in the liver (fatty liver)(11).

    Boston Public Health Commission recommends against giving salicylate-containing medications to children under 18 years of age (12).

    1. Metabolic acidosis: The American Academy of Pediatrics reports metabolic acidosis as a side effect caused by maternal salicylate dosage. Metabolic acidosis is a condition where the pH of the body fluids, including blood, decreases and causes excessive acidity. Acidosis quite commonly occurs due to a problem in the kidneys, which are responsible for maintaining the normal acidity of the body(13).

    Even though there are no studies to prove that the salicylates in Pepto-Bismol have the same side effects as that in Aspirin, it is safe to avoid it during breastfeeding, considering that salicylic acid can pass into breast milk.

    What Are The Alternatives To Pepto-Bismol?

    There are both medicinal and non-medicinal alternatives to Pepto-Bismol.

    1. Increased fluid intake, avoiding acidic foods, chewing ginger: Try avoiding acidic foods, chewing a piece of ginger or licorice. But, if your symptoms do not subside in a day, then consult a doctor and take the appropriate medication.
    1. Sodium bicarbonate and calcium carbonate-based antacids: You can consider antacids made with sodium bicarbonate (baking soda) to relieve acidity. These compounds have a localized effect within the stomach, and maternal dosage is seldom known to cause side effects in a breastfeeding baby (14).
    1. Simethicone: It provides relief from gas, fullness, and abdominal discomfort (15).Simethicone is considered relatively safe during breastfeeding as it is said to be unabsorbable from the maternal gastrointestinal tract. Even if it is absorbed, minute amounts are found in the breast milk. But, consult your doctor before taking Simethicone.
    1. Loperamide: The compound is used for controlling diarrhea, including traveler’s diarrhea((16)). Studies found that loperamide is secreted in extremely small amounts in breast milk. Hence, the American Academy of Pediatrics considers loperamide compatible with breastfeeding (5). However, you should consult a doctor before using the medicine.
    1. Histamine-based medicines: Theyare used to suppress acid secretion during GER and provide relief (17). Among the various histamine-based drugs, Famotidine has been found to be least secreted into breast milk (14). Having said that, animal studies proved that some histamine-based medicines such as Nizatidine and Cimetidine could pose a health risk. Therefore, seek professional advice before taking these medications.
    1. Proton-pump inhibitors: This class of medicines, including esomeprazole and omeprazole(18)(19), help regulate the production of acid by the stomach to prevent acidity. A low, regulated dosage of these medicines is unlikely to cause any side effects in the breastfeeding baby(20).

    Always consult your doctor before having any medicine during lactation because when you are lactating, the safety of the baby matters the most. Try natural remedies at first, although in consultation with the doctor. If they don’t help, check for alternatives as recommended by the medical professional.

    Did you have to take Pepto-Bismol while breastfeeding? Tell us about your experience in the comment section below. 

    This post is for informational purposes only and is not a replacement for a doctor’s consultation. Do not use any medication without talking to your doctor.

    References:

    1. Pepto-bismol- bismuth subsalicylate; The Procter & Gamble Manufacturing Company
    2. Bismuth subsalicylate; Medical Pharmacology; Tulane School of Medicine
    3. Pepto-bismol FAQs; Pepto-Bismol Official Website
    4. Food-borne and waterborne illness; Centers for Disease Control and Prevention
    5. Lin H. Chen, et.al.; Breastfeeding travellers: precautions and recommendations; Journal of Travel Medicine (2010)
    6. Aspirin; Drugs and Lactation Database; NCBI
    7. Bismuth subsalicylate; Drugs and Lactation Database; NCBI
    8. Julie J. Kelsey, Pharm.D; Drug principles in lactation; Pharmacotherapy Self-Assessment Program 2016-2018; Ameircan College of Clinical Pharmacy
    9. Bismuth subsalicylate; Toxnet Toxicology Data Network; U.S National Library of Medicine
    10. Over-the-counter medicines for infants and children; Encyclopedia; University of Rochester Medical Center
    11. Reye’s syndrome information page; National Institute of Neurological Disorders and Stroke
    12. Reye’s syndrome; Boston Public Health Commission
    13. Metabolic acidosis; Medical Encyclopedia; U.S National Library of Medicine
    14. Philip O. Anderson; Treating gastroesophageal reflux and heartburn while breastfeeding; Breastfeeding Medicine; Mary Ann Liebert Inc. Publishers
    15. A Young Seo, Nayoung Kim, and Dong Hyun Oh; Abdominal bloating: Pathophysiology and treatment; Journal of Neurogastroenterology and Motility
    16. Loperamide; Medline Plus; U.S National Library of Medicine
    17. H2 Blockers; International Foundation for Gastrointestinal Disorders
    18. Esomeprazole; Medline Plus; U.S National Library of Medicine
    19. Omeprazole; Medline Plus; U.S National Library of Medicine
    20. Esomeprazole; Toxnet Toxicology Network; U.S National Library of Medicine

     

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