Medicines Q&As
Q&A 93.3
Is it safe for breastfeeding women to take herbal medicines?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Before using this Q&A, read the disclaimer at www.ukmi.nhs.uk/activities/medicinesQAs/default.asp
Date prepared: 29th March 2012
Background
A comparison of two national surveys in the United States showed that between 1997 and 2002,
herbal medicines use rose by over 50% (1). In the United States, women between 30 and 50 years
old are the most likely users of complementary health care products (2). A trend in herbal medicine
use similar to that in the United States has been observed in the United Kingdom. It is likely therefore
that many women are using herbal medicines during lactation, probably for reasons such as postpartum depression, to increase/decrease milk supply and to relieve physical discomfort associated
with breastfeeding. The exact extent of herbal medicine use by women in the United Kingdom during
lactation is unknown. However, a survey conducted among 600 Norwegian women found that of the
women who had previously breastfed a child, 37.3% had used herbal medicines to increase milk
production (3).
Answer
Scientific information on the safety of herbal medicines during lactation is scarce and a literature
search revealed no rigorous trials in this area. Whether or not many herbal medicines pass into breast
milk is unknown. Furthermore, contamination of herbal medicines with substances such as
conventional medicines, pesticides and heavy metals cannot be ruled out. In view of the lack of safety
data, it is generally advised that breastfeeding mothers avoid taking herbal medicines (4,5).
There is a scarcity of reports in the literature concerning breastfed infants who have experienced
adverse effects associated with herbs ingested by their mothers, but the assumption must not be
made that herbal medicines are unlikely to cause problems in breastfed infants. One published report
suggested that a soup made of dong quai was the cause of hypertension in a mother and her threeweek-old baby. The baby’s blood pressure returned to normal when breastfeeding was discontinued
for a couple of days (6). Another report has been found of an exclusively breastfed 9 day old term
male infant who presented with a one day history of lethargy, decreased milk intake, anaemia and
jaundice (7). The lactating mother, who was asymptomatic, had started drinking tea made from arnica
flowers 48 hours before the onset of symptoms. Exchange transfusions were used to lower the
infant’s bilirubin and correct the anaemia. The mother stopped drinking the tea and resumed
breastfeeding, and no further haemolysis or other problems were noted in the infant (7).
A few herbs have the potential to harm infants exposed to them via breast milk. Among these are
herbs containing pyrrolizidine alkaloids (PAs), some of which can be hepatotoxic if taken orally (8).
Some herbal teas may also contain PAs; exact ingredients are not always listed on the herbal tea and
it has been advised that lactating mothers limit their exposure to herbal teas and avoid those of
unknown composition (9). Some sources advise against the use of herbs containing anthranoids
(other than senna) (8,10). Anthranoids have laxative effects and are partially excreted into breast milk
(8).
Examples of herbs that are contraindicated in breastfeeding are provided below, this list is not
exhaustive:
Aloe (oral), buckthorn berry and bark, blue cohosh, cascara sagrada bark, coltsfoot, comfrey,
germander, gordolobo yerba tea, Indian snakeroot, jin bu huan, kava kava, margosa oil, mate tea,
mistletoe, pennyroyal oil, Petasites root, rhubarb root, sage, skullcap and uva ursi (11).
Available through NICE Evidence Search at www.evidence.nhs.uk
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Medicines Q&As
Examples of herbal medicines that might be selected by breastfeeding women are given below with a
brief discussion of the safety concerns associated with them:
Herbs for physical discomfort related to breastfeeding
Comfrey is a PA-containing herb sometimes used by breastfeeding mothers on their nipples to
prevent dry, cracked skin. According to one US source, it has been associated with hepatic
venoocclusive disease in infants and should be avoided (12). A further source advises against the use
of comfrey and members of this Boraginacae family in breastfeeding mothers when administered
topically, orally or in any form (9).
One report has been published of a 17-day-old infant with a generalised urticaria whose mother had
applied water boiled with stinging nettle onto her nipples twice a day (before and after each
breastfeed) for two days in order to heal her nipple cracks. Serum total immunoglobulin E (IgE) and
specific IgE levels for stinging nettle were high in both the infant and the mother. The rashes
disappeared completely by the second day without treatment. A skin prick test with the water boiled
with stinging nettle was positive for the infant with significant induration, but not for the mother (13).
In any case of topical treatment, washing the breast after the application and before breastfeeding is
recommended (14).
Herbs to increase milk production
Herbal medicines reported to be commonly used as galactagogues, i.e. to increase milk production
include alfalfa, anise, blessed thistle, fenugreek and fennel (15,16). Other well-known galactagogues
are milk thistle, chasteberry (8), goat’s rue, shatavari (asparagus racemosus), caraway seed, dill and
borage (17). Borage may contains PAs (18) and should be avoided by breastfeeding mothers.
An uncontrolled study found that ten women who used breast pumps to express milk noted a
statistically significant increase in breast milk production (p=0.004) when they took three capsules of
fenugreek seed three times a day. No side effects were reported in their infants, but the published
information on the study is too brief to determine whether study participants were questioned about
side effects (19). A small study assessed mothers who received at least 3 cups of herbal tea
containing fenugreek (n=22) daily against placebo apple tea (n=22) and a control group (n=20) who
were not advised any special recommendations. Infants in the fenugreek tea group regained their
birth weight earlier than those in the control and placebo groups (6.7 ± 3.2 days in the fenugreek
group versus 7.3 ± 2.7 days in the placebo group versus 9.9 ± 3.5 days in the control group, p<0.05).
The mean measured breast milk volume of the mothers who received fenugreek tea was significantly
higher than the placebo or control groups (73.2 ± 53.5mL in fenugreek group versus 38.8 ± 16.3mL in
the placebo group versus 31.1 ± 12.9mL in the control group, p<0.05) (20). However a case has been
reported in which gastrointestinal bleeding occurred in a premature (30 weeks) baby, whose mother
had received fenugreek (11). Though the proportion of a fenugreek dose that passes into human milk
is unknown, passage does occur and the infant’s urine may smell like maple syrup, as with Maple
Syrup Urine Disease (21). The mother may also experience a maple-like smell of urine, breast milk
and perspiration (22). Colic, abdominal discomfort and diarrhoea have been reported in babies whose
mothers took fenugreek (23). The nursing mother should avoid taking fenugreek if they have a history
of asthma, allergic reactions or diabetes or take antihypertensives, anticoagulants or antiplatelets
(23,24).
Blessed thistle, though reported to have low toxicity, can cause hypersensitivity reactions and has
laxative properties. It is not known whether blessed thistle passes into breast milk (21).
Any herbs that might have hormonal effects, e.g. chasteberry (also known as agnus castus) should be
avoided during lactation. Chasteberry is used to relieve symptoms of mastalgia, its hormonal activity
however can inhibit prolactin secretion and thus suppress milk production (21). Similarly, alfalfa (25)
and fennel are not recommended during breastfeeding because they might have oestrogenic
properties, which could actually inhibit breast milk production (11). Neurotoxicity (hypotonia, lethargy,
emesis, weak cry and poor sucking) has been reported in two breastfed infants whose mothers drank
an herbal tea that included fennel, liquorice, goat's rue and anise (26). It has also been advised that
caraway oil, which is extracted from the seeds, is avoided by breastfeeding mothers (27).
Available through NICE Evidence Search at www.evidence.nhs.uk
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Medicines Q&As
Milk thistle contains flavolignans, which may act on oestrogen receptors (ER2) by limiting the
endogenous receptors' antagonism of milk production (22). A small, non-randomised, unblinded study
compared 25 women who received micronised milk thistle (420mg daily) for 63 days against 25
placebo-controlled women. The authors reported an 86% increase in daily milk production in the
treated group versus 32% increase in the placebo group (28). However limited information was
available regarding the infants and their mothers (28). Possible adverse effects of milk thistle include
allergic reactions and mild laxative effects (8).
The effects of asparagus (asparagus racemosus) on lactation have been investigated in three clinical
studies (29-31). In the first, a randomised, placebo-controlled study involving 64 mothers (n=32 in
each group) who had reported lactational deficiency, a galactagogue containing asparagus
racemosus as the ‘active ingredient’ did not increase milk production or prolactin hormone levels. No
significant side effects were reported in this study (29). In the second, non-blinded study, a definite
increase in milk production was reported by 11 of the 15 women involved (29,30). In contrast to the
first study, a double-blind, randomised, placebo-controlled, parallel group study involving 60 lactating
mothers (n=30 in each group) showed an increase in mean prolactin hormone level three times higher
in the mothers in the research group than those in the control group (32.87 ± 6.48 versus 9.56 ± 4.57,
p<0.05). The average percentage increase in the weight of babies was 16.13 ± 3.65 versus 5.68 ±
2.57 in the control group (p<0.05) (31).
A small study in 82 women indicated that the use of the traditional Japanese herbal medicine Xionggui-tiao-xue-yin (an extract of 13 herbs) in the postpartum period stimulates lactation. The herbal
medicine treated group (n=41) had higher plasma prolactin concentrations on days 1 and 6
postpartum compared to the group treated with ergometrine 0.375mg/day (n=41). The herbal group
also produced statistically significantly greater quantities of milk (measured by baby weight) on days 4
to 6 compared to the ergometrine group. Although no adverse effects were reported in the mothers,
no data was provided on the wellbeing of the infants (32).
Overall, there is not enough available information to support the use of fenugreek, anise, chasteberry,
alfalfa, fennel, borage, blessed thistle, milk thistle, goat’s rue, dill, caraway or asparagus in nursing
mothers (18,22,25,27,29,33-40). The use of galactogogues (mainly non-herbal) has been recently
reviewed in the UKMi Q&A ‘Drug treatment of inadequate lactation’ (41).
Herbs which decrease milk supply
Sage is thought to reduce a lactating mother's milk supply (42). Some recommend using it during the
process of weaning (14,43). Other herbs reported to decrease milk supply include peppermint,
spearmint, parsley, chickweed, black walnut, stinging nettles, yarrow, Herb Robert, lemon balm,
oregano, periwinkle herb, and sorrel (14,43).
St John’s Wort for post-natal depression
The management of depression with complementary medicines has recently been reviewed in an
UKMi Q&A ‘Management of depression in breastfeeding mothers – are St John’s Wort and other
complementary therapies safe?’ (44).
Although there is some evidence that St John’s Wort may be of benefit in treating mild to moderate
depression, NICE advises that it should not be prescribed or recommended for use by patients
because of uncertainty about appropriate doses, variation in the nature of preparations and potential
serious interactions with other medicines (45,46). Some evidence exists for the safety of St John’s
Wort during breastfeeding, but further investigation is required (47,48). For the time being, it is
recommended that women do not self medicate with St John’s Wort (45). Infants exposed to St John’s
Wort during breastfeeding should be monitored for adverse effects, particularly sedation and poor
feeding. Prematurity or illness would set infants at greater risk of adverse effects from exposure to St
John’s Wort and its use in mothers who are breastfeeding such infants should be avoided (44).
Available through NICE Evidence Search at www.evidence.nhs.uk
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Medicines Q&As
Other commonly used herbs
Black cohosh: Caution is recommended. Black cohosh could have oestrogenic and/or
antioestrogenic activity (49). Theoretically therefore black cohosh might negatively affect breast milk
production due to its oestrogenic effects (11).
Coenzyme Q10: It is likely that coenzyme Q10 passes into breast milk (11). Because of the lack of
safety data, it is recommended that coenzyme Q10 is avoided by breastfeeding mothers (11).
Echinacea: Tinctures of echinacea can contain high amounts of alcohol which would be
contraindicated in nursing mothers (21). Although it is generally well tolerated, allergic reactions are
possible with echinacea (21). It is not known whether echinacea transfers into breast milk or affects
lactation (11). Echinacea should be used with caution until there is further evidence to support its
safety (50).
Garlic: Passage of garlic into breast milk may affect the smell and taste of breast milk and, ideally,
large amounts should be avoided. There are anecdotal reports of colic in infants following exposure to
garlic through breast milk (21).
Ginkgo biloba: There is nothing in the evidence-based medical literature to suggest that ginkgo leaf
is safe or unsafe during breastfeeding. Medicinal use of raw ginkgo seeds might not be safe during
lactation, according to a toxicology compendium (51). Known adverse effects include gastrointestinal
upset, headache, dizziness, constipation, and of more concern are reports of spontaneous bleeding
(52). Until further information becomes available, use of ginkgo during breastfeeding is probably best
avoided.
Ginseng (Panax): It is not known whether ginseng passes into breast milk, but caution is
recommended (11). There is conflicting information as to whether ginseng has oestrogenic effects
(53,54). Oestrogens are known to suppress breast milk production.
Valerian: Tinctures of valerian may contain high amounts of alcohol which would be contraindicated
in nursing mothers (21). No data on excretion into breast milk are available (11). Side effects include
headache, gastric discomfort, morning drowsiness, insomnia, cardiac disturbances and vivid dreams
(55). Herbs with sedative constituents are usually avoided in nursing infants due to the potential risks
of lethargy and poor weight gain in the infant and concerns over potential risks of sudden infant death
syndrome (21).
Practical Information
Although it is not currently recommended, if a breastfeeding woman does decide to take an herbal
medicine, it should be with the knowledge of a healthcare professional (e.g. health visitor, doctor or
pharmacist) and the product should come from a reputable source. It is also important to take into
consideration why a woman wishes to take an herbal medicine as undiagnosed illness that remains
untreated by conventional methods might result in harm to the individual.
As for conventional medicines taken during breastfeeding, the risk of adverse events is greater in
premature or very young infants and in those with a concurrent illness.
Summary

It is generally advised that breastfeeding mothers avoid herbal medicines. This is due to the
lack of information on whether or not various herbal medicines pass into breast milk, and of
scientific safety data. Furthermore, contamination of herbal products with conventional
medicines, pesticides or heavy metals cannot be ruled out.

Herbs containing pyrrolizidine alkaloids (PAs) can be hepatotoxic and are therefore potentially
harmful to any infants exposed to them via breast milk.
Available through NICE Evidence Search at www.evidence.nhs.uk
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Medicines Q&As

Some sources advise against the use of plants containing anthranoids, which have laxative
effects.

Other herbal medicines have hormonal effects which would render them unsuitable for
breastfeeding women.

Herbal medicines that contain constituents with sedative properties should be avoided due to
the potential adverse effects in the infant.

Although there is some evidence that St John’s Wort may be of benefit in treating mild to
moderate depression, NICE advises that it should not be prescribed or recommended for use
by patients because of uncertainty about appropriate doses, variation in the nature of
preparations and potential serious interactions with other medicines. Some evidence exists
for the safety of St John’s Wort during breastfeeding, but further investigation is required. For
the time being, it is recommended that women do not self medicate with St John’s Wort.
Infants exposed to St John’s Wort during breastfeeding should be monitored for adverse
effects, particularly sedation and poor feeding.

If an herbal medicine is taken during breastfeeding, it should be with the knowledge of a
healthcare professional (e.g. health visitor, GP, pharmacist) and the products should come
from a reputable source.

Healthcare professionals should take into consideration why a woman wishes to take an
herbal medicine. Undiagnosed illness that remains untreated by conventional methods might
result in harm to the individual.

The risk of adverse events in a breastfed infant is higher for premature or very young infants
and in those with a concurrent illness.
Limitations
There is a lack of published scientific information on the safety of herbal medicines in breast fed
infants and on whether or not various herbal medicines pass into breast milk. The list of herbal
medicines included in this review is not exhaustive, absence from this Q&A does not imply that an
herbal medicine is safe to use in breastfeeding.
References
(1) Tindle HA, Davis RB, Phillips RS et al. Trends in use of complementary and alternative medicine
by US adults: 1997-2002. Altern Ther Health Med. 2005;11:42-9.
(2) Ritchie HE. The safety of herbal medicine: use during pregnancy. Frontiers in Fetal Health.
2001;3:259-66. In: Conover EA. Herbal agents and over-the-counter medications in pregnancy.
Best Pract Res Clin Endocrinol Metab. 2003;17:237-51.
(3) Nordeng H, Bayne K, Havnen GC, et al. Use of herbal drugs in pregnancy among 600 Norwegian
women in relation to concurrent use of conventional drugs and pregnancy outcome. Complement
Ther Clin Pract. 2011;17:147-51.
(4) Medicines Control Agency. Safety of herbal medicinal products, July 2002. Available from:
http://www.mhra.gov.uk/home/groups/es-herbal/documents/websiteresources/con009293.pdf
[cited 23/2/12].
(5) UK Drugs in Lactation Advisory Service, UKMi. Available from:
http://www.ukmicentral.nhs.uk/drugpreg/guide.htm [cited 25/02/10].
(6) Nambiar S, Schwartz RH, Constantino A. Hypertension in mother and baby linked to ingestion of
Chinese herbal medicine. West J Med. 1999;171:152.
(7) Miller AD, Ly BT, Clark RF. Neonatal hemolysis associated with nursing mother ingestion of
arnica tea [abstract]. Clin Toxicol. 2009;47:726.
(8) Kopec K. Herbal medications and breastfeeding. J Hum Lact 1999;15:157-61.
(9) Hale TW, editor. Medications and mothers’ milk. 10th edition. Amarillo: Pharmasoft Publishing;
2002, p350-1.
Available through NICE Evidence Search at www.evidence.nhs.uk
5
Medicines Q&As
(10) Westendorf J. Anthranoid derivatives – General discussion. In: De Smet PAGM. Keller K, Hansel
R, Chandler RF, eds. Adverse effects of herbal drugs. Vol 2. New York: Springer-Verlag,
1993:105-18. In Kopec K. Herbal medications and breastfeeding. J Hum Lact. 1999;15:157-61.
(11) Hale TW, editor. Medications and mothers’ milk [Internet]. Hale Publishing; 2011. Available from:
http://www.medsmilk.com/ [cited 13/3/12].
(12) Rouse D. Herbs to be avoided during lactation - AltMedDex® Consults. In: Klasco RK (Ed):
AltMedDex® System (electronic version). Thomson Micromedex, Greenwood Village, Colorado,
USA. Available from: http://www.thomsonhc.com [cited 9/2/12].
(13) Uslu S, Bulbul A, Diler B, et al. Urticaria due to Urtica dioica in a neonate [abstract]. Eur J Pediatr.
2011;170:401-3.
(14) Lawrence R and Schaefer C. Alternative remedies, vitamins, and minerals. In: Schaefer C, Peters
P, Miller RK, editors. Drugs during pregnancy and lactation. Treatment options and risk
assessment. 2nd ed. London: Elsevier BV; 2007. p.771-8.
(15) Herbal remedies for increasing milk supply. Kellymom breastfeeding and parenting web site.
Available from: http://www.kellymom.com/herbal/milksupply/herbal-rem_a.html [cited 3/3/12].
(16) The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use of
Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion. Breastfeed Med.
2011;6:41-9
(17) Low Dog T. The use of botanicals during pregnancy and lactation. Altern Ther Health Med.
2009;15:54-8.
(18) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Borage monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(19) Swafford S and Berens P. Effect of fenugreek on breast milk volume. ABM News and Views.
2000;6:21. Annual Meeting Abstracts. September 11-13.
(20) Turkyilmaz C, Onal E, Hirfanoglu IM, et al. The effect of galactagogue herbal tea on breast milk
production and short-term catch-up of birth weight in the first week of life. J Altern Complem Med.
2011;17:139-42.
(21) Conover E and Buehler BA. Use of herbal agents by breastfeeding women may affect infants.
Pediatr Ann. 2004;33:235-40.
(22) Zuppa AA, Sindico P, Orchi C, et al. Safety and efficacy of galactogogues: substances that
induce, maintain and increase breast milk production. J Pharm Pharmaceut Sci. 2010;13:162-74.
(23) Tiran D. The use of fenugreek for breast feeding women. Complement Ther Nurs Midwifery.
2003;9:155-6.
(24) Bonyata K. Fenugreek seed for increasing milk supply. Kellymom breastfeeding and parenting
web site. Available from: http://kellymom.com/bf/can-i-breastfeed/herbs/fenugreek/ [cited 4/3/12],
(25) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Alfalfa monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(26) Rosti L, Nardini A, Bettinelli ME, Rosti D. Toxic effects of a herbal tea mixture in two newborns.
Acta Paediatrica. 1994;83:683.
(27) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Caraway monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(28) Carotenuto D, DiPierro F. Studio sulla tollerabilità ed efficaciadella silimarina BIO-C ® (Piùlatte ®)
micronizzata come galattagogo. Acta Neonatologica & Pediatrica. 2005;4:393-40. In: Zuppa AA,
Sindico P, Orchi C, et al. Safety and efficacy of galactogogues: substances that induce, maintain
and increase breast milk production. J Pharm Pharmaceut Sci 2010;13(2):162-74.
(29) Sharma S, Ramji S, Kumari S et al. Randomized, controlled trial of asparagus racemosus
(Shatavari) as a lactogogue in lactational inadequacy. Indian Pediatr. 1996;33:675-7.
(30) Joglekar GV, Ahuja RH, Balwani JH. Galactogogue effect of Asparagus racemosus. Preliminary
communication. Indian Med J. 1967;61:165.
(31) Gupta M and Shaw B. A double-blind randomized clinical trial for evaluation of galactogogue
activity of Asparagus racemosus Willd. Iranian Journal of Pharmaceutical Research. 2011;10:16772.
(32) Ushiroyama T, Sakuma K, Souen H, et al. Xiong-gui-tiao-xue-yin (Kyuki-chouketsu-in), a
traditional herbal medicine, stimulates lactation with increase in secretion of prolactin but not
oxytocin in the postpartum period. Am J Chin Med. 2007;35:195-202.
Available through NICE Evidence Search at www.evidence.nhs.uk
6
Medicines Q&As
(33) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Fenugreek monograph.
Natural Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012.
Available from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited
3/3/12].
(34) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Anise monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(35) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Blessed thistle monograph.
Natural Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012.
Available from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited
3/3/12].
(36) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Dill monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(37) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Milk thistle monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(38) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Goat’s rue monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(39) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Chasteberry monograph.
Natural Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012.
Available from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited
3/3/12].
(40) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Fennel monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(41) UKMi Q&A 73.4: Drug treatment of inadequate lactation. Available from:
http://www.medicinesresources.nhs.uk/upload/documents/Evidence/Medicines Q & A/Drugtreatment-of-inadequate-lactation/ [cited 28/3/12].
(42) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Sage monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(43) Too much milk: sage and other herbs for decreasing milk supply. Kellymom breastfeeding and
parenting web site. Available from: http://www.kellymom.com/herbal/milksupply/herbsoversupply.html [cited 4/3/12].
(44) UKMi Q&A 254.2: Management of depression in breastfeeding mothers – Are St. John’s Wort and
other complementary therapies safe? Available from:
http://www.medicinesresources.nhs.uk/upload/documents/Evidence/Medicines Q &
A/Management-of-depression-in-breastfeeding-mothers-Are-St-Johns-Wort-and-othercomplementary-therapies-safe/ [cited 9/2/12].
(45) National Institute for Health and Clinical Excellence. Depression: The treatment and management
of depression in adults. NICE Clinical Guideline 90, October 2009. Available from:
www.nice.org.uk/cg90 [cited 3/3/12].
(46) Dugoua J-J, Mills E, Perri D et al. Safety and efficacy of St John’s Wort (Hypericum) during
pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e268-e276.
(47) Klier CM, Schmid-Siegel B, Schafer MR et al. St. John’s Wort (Hypericum perforatum) and
breastfeeding: plasma and breast milk concentrations of hyperforin for 5 mothers and 2 infants. J
Clin Psychiatry. 2006;67:305-9.
(48) Lee A, Minhas R, Matsuda N, Lam M, Ito S. The safety of St. John’s Wort (Hypericum perforatum)
during breastfeeding. J Clin Psychiatry. 2003;64:966-8.
(49) Dugoua J-J, Seely D, Perri D et al. Safety and efficacy of black cohosh (Cimicifuga racemosa)
during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e257-e261.
(50) Dugoua J-J, Mills E, Perri D et al. Safety and efficacy of Echinacea (Echinacea angustifolia, E
purpurea and E. pallida) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e262e267.
(51) Dugoua J-J, Mills E, Perri D et al. Safety and efficacy of ginkgo (Ginkgo biloba) during pregnancy
and lactation. Can J Clin Pharmacol 2006;13:e277-e284.
Available through NICE Evidence Search at www.evidence.nhs.uk
7
Medicines Q&As
(52) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Ginkgo monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
(53) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Ginseng, Panax monograph.
Natural Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012.
Available from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited
3/3/12].
(54) Seely D, Dugoua J-J, Perri D et al. Safety and efficacy of Panax Ginseng during pregnancy and
lactation. Can J Clin Pharmacol 2008;15:e87-e94.
(55) Jellin JM, editor-in-chief; Gregory PJ, Batz F, Bonakdar R, editors. Valerian monograph. Natural
Medicines Comprehensive Database. Stockton: Therapeutic Research Faculty; 2012. Available
from: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND [cited 3/3/12].
Quality Assurance
Prepared by
Anna Burgess, Welsh Medicines Information Centre, University Hospital of Wales (based on earlier
work by Alex Bailey)
Date Prepared
29th March 2012
Checked by
Gail Woodland, Welsh Medicines Information Centre, University Hospital of Wales
Date of check
30th March 2012
Acknowledgements
We would like to thank Peter Golightly (Director, Trent Medicines Information Service) for his helpful
comments.
Search strategy
 Embase ([herbal medicine OR exp medicinal plant] AND [breast milk OR lactation OR breast
feeding] Limit year: 2009 to current)
 Medline ([exp plants, medicinal OR exp drugs, Chinese herbal OR phytotherapy OR exp herbal
medicine] AND [milk, human OR exp lactation OR exp breast feeding] Limit year: 2009 to current)
 NeLM (“herbal medicines” AND breast)
 IDIS (herbal medicines 92510000 OR Chinese herbal medicines 92510129 AND lactating mother
v24.1 OR PKIN excretion milk 24. Limit year: 2009-2012)
 AltMedex (lactation) (herbal medicine name)
 Natural Medicines Comprehensive Database (herbal medicine name)
 Herbal medicines online (herbal medicine name)
 United Kingdom Drugs in Lactation Advisory Service (UKDILAS), Trent and West Midlands
Medicines Information Service.
Available through NICE Evidence Search at www.evidence.nhs.uk
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