In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
Pepto-Bismol helps relieve several digestive issues that pregnant and breastfeeding women often experience, including gas, heartburn, and nausea.
Many women may be aware that they should avoid taking Pepto-Bismol during pregnancy, but what about while breastfeeding?
It is unclear whether Pepto-Bismol is safe to take while breastfeeding, but most experts recommend avoiding it. Read on to learn more.
Pepto-Bismol’s active ingredient is bismuth subsalicylate, a type of salicylate. Aspirin’s other name is acetylsalicylic acid, which is another type of salicylate.
Researchers are unsure if bismuth subsalicylate passes into a woman’s breast milk. Other types of salicylates, including aspirin, do enter the breast milk, and they can have harmful effects on a developing baby.
Some research into aspirin use reports that serum levels of salicylates in breastfeeding infants can reach approximately 40 percent of the dose taken by the woman.
As a result, the American Academy of Pediatrics recommend that doctors use caution when recommending medications containing salicylates to breastfeeding women.
The National Institutes of Health in the United States suggest that breastfeeding women use alternatives to Pepto-Bismol because the active ingredient may pass into breast milk.
The risks of using Pepto-Bismol while breastfeeding are not well-documented. However, in very rare cases, salicylates have been linked to Reye’s syndrome in children.
Reye’s syndrome is a severe and potentially fatal condition that causes swelling of the brain and liver.
Due to the risk of Reye’s syndrome, experts recommend that breastfeeding women seek alternatives to medications that contain salicylate, such as Pepto-Bismol.
Other risks associated with Pepto-Bismol use include:
- a black, hairy appearance to the tongue
- black stool
- internal bleeding
These effects are temporary and go away within a few days of stopping use.
In rare cases, Peptol-Bismol can cause ringing in the ears. If a person experiences this side effect, they should stop taking the medication and see a doctor immediately.
Also, Pepto-Bismol may interact with other medications, such as:
- angiotensin converting enzyme inhibitors, or ACE inhibitors
- aspirin and other types of salicylate
- blood thinners
- diabetes medications
- gout medications
- nonsteroidal anti-inflammatory drugs, or NSAIDs
- some antiseizure drugs
- some medications for irritable bowel syndrome
- tetracycline antibiotics
Speak to a doctor before taking Pepto-Bismol, especially if pregnant, breastfeeding, or taking other medications.
Some home remedies and medications can safely treat digestive problems while breastfeeding.
Diarrhea usually clears up within a few days without treatment. To reduce symptoms and discomfort during this time, a person should:
Diarrhea causes the body to lose fluid. Staying hydrated is essential while breastfeeding because dehydration can reduce the milk supply.
To replace any lost fluids, drink plenty of liquids. Healthful options include:
- diluted fruit juices
- clear broths
- rehydrating solutions
- isotonic drinks, which include many sports drinks
Avoid problematic foods
Some foods can make diarrhea worse. These trigger foods vary from person to person, but some of the most common culprits include:
- fatty foods
- fried foods
- spicy meals
- dairy products
See a doctor
If diarrhea persists for more than 2 days, see a doctor. They can help determine the cause and provide treatment options.
A doctor may recommend a medication that contains loperamide, such as Imodium, Maalox Antidiarrheal, or Pepto Diarrhea Control. These are generally safe to take while breastfeeding.
However, it is best to consult a doctor before taking any antidiarrheal preparation, including Pepto-Bismol.
Some women experience nausea while breastfeeding. It may result from hormonal changes, mild dehydration, or low blood sugar.
To treat nausea at home, it can help to try:
- drinking ginger or peppermint tea
- taking vitamin B6 supplements
- wearing antinausea or seasickness bands on the wrists
- drinking plenty of fluids to avoid dehydration
- eating frequent, nutritious meals to avoid low blood sugar
Treating acid reflux or heartburn
Lifestyle changes can often provide significant relief from heartburn. These are also the safest options for pregnant and breastfeeding women.
If home remedies do not work, a doctor can recommend safe medications.
To alleviate heartburn and acid reflux, a breastfeeding woman can try:
- eating several small meals a day, instead of three large ones
- drinking water between meals, rather than with meals
- chewing food thoroughly
- not eating for 2–3 hours before bed.
- avoiding fatty, spicy, or acidic foods, carbonated drinks, chocolate, and caffeine
- not lying down during or after meals
- going for a light stroll after eating to encourage digestion
- ensuring that clothing is loose around the stomach
- sleeping on the left side of the body
- elevating the head with pillows or bed risers
Some heartburn medicines may be safe to use while breastfeeding. Talk to your doctor before using over-the-counter medications, including:
- cimetidine (Tagamet)
- famotidine (Pepcid)
- nizatidine (Axid)
- omeprazole (Prilosec)
Breastfeeding women who are experiencing heartburn, nausea, diarrhea, or other digestive complaints should contact a doctor for advice and treatment.
It is also essential to ask a doctor about the safety of any medication, including Pepto-Bismol, while breastfeeding.
If the doctor advises against using one medication, they can recommend others or drug-free treatments.
The available research suggests that Pepto-Bismol is not safe to take while breastfeeding. While there is no conclusive evidence that bismuth subsalicylate passes to the infant through breast milk, other salicylates do.
As a result, most authoritative organizations recommend avoiding salicylates while breastfeeding.
Alternative treatments are available to relieve digestive issues in breastfeeding women. For further information, speak with a doctor or pharmacist.