Medicines Q&As

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 https://www.sps.nhs.uk/articles/about-ukmi-medicines-qas/
Date prepared: 20th May 2019

Background
The prevalence of herbal medicine use by women in the United Kingdom (UK) during lactation is
unknown. A survey conducted in Norway among 600 women found that, of the women who had
previously breastfed a child, 37.3% had used herbal medicines to increase milk production (1). In
Western Australia, a survey of women who had breastfed in the last 12 months found that 59.9% of
the 304 responders took at least one herb during breastfeeding for medicinal purposes and in 60%
the reason for use was breastfeeding-related. Less than a third of users had informed their GP they
were planning to take the herbal medicine (2).

Similarly, an Italian web-based survey conducted over six years showed that 52.6% of the 388
responders included in the analysis had used complementary medicines (including herbal or
phytotherapeutic preparations) during breastfeeding. Of these women, 65% had no scientific
information about the possible risks of complementary medicines, but 73% considered them to be as
safe as/ safer than conventional medicines (3). A publication reporting an increase in phone calls on
the use of herbal galactagogues to an Australian pregnancy and lactation counselling service
between 2001 and 2014 from 0% to 23% of all calls suggested that members of the public, but also
some healthcare professionals, are increasingly seeking information surrounding their use (4).

It is likely that many women in the UK are using herbal medicines during lactation, probably for
reasons such as post-partum depression, to increase/decrease milk supply and to relieve physical
discomfort associated with breastfeeding. Further research is required to determine the extent of use
and the safety and efficacy of herbs in common usage by breastfeeding mothers.

Answer
Scientific information on the safety of herbal medicines during lactation is scarce and a literature
search revealed no rigorous trials in this area. The amounts of pharmacologically active components
of herbal medicines that pass into breast milk are largely unknown. 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. The
safety of many herbal medicines has not been established in breastfeeding women and it is
recommended that a doctor or pharmacist is contacted before using a herbal medicine during
breastfeeding (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 three-
week-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).

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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).
Studies analysing the contents of herbal teas have confirmed the presence of PAs (9, 10), and it has
been concluded that they could be harmful in breast feeding and pregnant women if consumed long
term (10). Some sources advise against the use of herbs containing anthranoids (other than senna)
(8,11). Anthranoids have laxative effects and are partially excreted into breast milk (8).

It is recommended that the following herbs are avoided by breastfeeding mothers. This list is not
exhaustive:

Aloe (oral) (12), blue cohosh (13), borage (13), buckthorn (12), comfrey (13), goldenseal (14), Indian
snakeroot, kava, male fern, European mistletoe, pennyroyal oil, podophyllum, rhubarb root, skullcap
and uva ursi (12).

Herbs with sedative constituents such as valerian are usually avoided during breastfeeding due to the
potential risks of lethargy and poor weight gain in the infant and concerns over potential risks of
sudden infant death syndrome (15). It is not known whether valerian transfers into human milk (13),
but the current advice is to avoid it in breastfeeding women (12,13), and, if necessary, to use
medicines for which more information is available on safety in breastfeeding (13).

Examples of herbal medicines that might be of particular interest to 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 (16). A further source advises against the use
of comfrey and other members of the Boraginaceae family in breastfeeding mothers when
administered topically, orally or in any form (13).

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 (17).

Other herbs that have been applied topically for breast problems during lactation include cabbage
leaf, green tea and jasmine flowers. Existing evidence suggests that there are no safety problems
associated with appropriate, topical and short-term use of cabbage leaves for breast engorgement
(12), but insufficient information is available on the safety of green tea and jasmine when used
topically during lactation (12).

In any case of topical treatment, washing the breast before breastfeeding is recommended (18).

Herbs to increase milk production

Herbal medicines reported to be commonly used as galactagogues, i.e. to increase milk production
include oats, alfalfa, fennel, blessed thistle, fenugreek (19), and anise (12, 20). Other well-known
galactagogues are milk thistle, chasteberry (8), goat’s rue, shatavari (asparagus racemosus), caraway
seed, dill and borage (21). Borage may contain PAs (12) and should be avoided by breastfeeding
mothers.

Fenugreek: 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
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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 mothers did
not report any adverse effects in themselves or the neonates (22). Similarly, no adverse effects were
seen in mothers or infants in a double-blind, placebo-controlled study in which 26 mothers of
premature infants (≤31 weeks gestation) received fenugreek (three 575mg capsules, three times a
day) or placebo for 21 days. In this study, milk volume and maternal prolactin levels were found not to
differ statistically significantly between the active and placebo groups (23). The two studies described
above were included in a recent network metaanalysis of studies that investigated the efficacy of
fenugreek as a galactagogue in breastfeeding mothers. The outcome was total volume of milk (per
day and per feed) and in the final analysis of four studies, fenugreek was found to increase breast
milk production more effectively than placebo (weighted mean difference (WMD) 11.12 (CI 95% 6.77,
15.46; p<0.001) Studies involved in the final analysis did not report any relevant safety data (24).

Clearly, safety information from studies is limited, but the existing evidence indicates that fenugreek is
probably compatible with breastfeeding (13). Nevertheless, a case has been reported in which
gastrointestinal bleeding occurred in a premature (30 weeks) baby, whose mother had received
fenugreek (11). Acute liver injury has been reported in a woman who took fenugreek for 6-8 weeks to
increase milk production in the second and third months postpartum. The patient was managed
conservatively, fenugreek was stopped and her liver function returned to normal. There was no re-
challenge (25).

Although 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 (15). This could be confused with maple syrup
urine disease. The mother may also experience a maple-like smell of urine, breast milk and
perspiration (26). Colic, abdominal discomfort and diarrhoea have been reported in babies whose
mothers took fenugreek (27) and fenugreek has demonstrated anticoagulant and hypoglycaemic
properties (13). Since fenugreek is from the Fabaceae plant family which includes peanuts,
chickpeas, green peas and soybeans, people who are allergic to members of the Fabaceae plant
family may also react to fenugreek (12). Breastfeeding mothers should seek further advice from a
healthcare professional if they have a history of asthma, allergic reactions or diabetes or take
antihypertensives, anticoagulants or antiplatelets.

Blessed thistle: Blessed thistle, though reported to have low toxicity, can cause allergic reactions
and gastrointestinal upset (13,18), and may have abortifacient properties (13). It is not known whether
blessed thistle passes into breast milk (15).

Milk thistle: Milk thistle contains flavonolignans, which may act on oestrogen receptors (ER2) by
limiting the endogenous receptors' antagonism of milk production (26). A small, non-randomised,
unblinded study compared 25 women who received micronised milk thistle (420mg daily) for 63 days
against 25 placebo-controlled women. At 63 days, the authors reported an 86% increase in daily milk
production in the treated group versus 32% increase in the placebo group (p<0.01) (28). The
proportions of water, fat, carbohydrate and protein in the milk were unchanged (29). Further, large-
scale, randomised, blinded studies would be useful to confirm these findings (28). In a separate
investigation that preceded the study, five healthy, lactating volunteers who had discontinued
breastfeeding their 9-month-old babies received micronised milk thistle 600mg three times a day. At
five days, silymarin flavonolignans were undetectable (i.e. <1ng/ml) on HPLC analysis of their milk
(28).

Possible adverse effects of milk thistle include allergic reactions, mild laxative effects (8,29), nausea,
and the potential for drug interactions as silymarin inhibits cytochrome P450, beta-glucuronidase and
P-glycoprotein (29). The available evidence for the safety of milk thistle during lactation is limited
(12,30).

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Shatavari (asparagus racemosus): The effects of shatavari (asparagus racemosus) on lactation

have been investigated in three clinical studies (31-33). 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 (31). In
the second, non-blinded study, a definite increase in milk production was reported by 11 of the 15
women involved (31,32). The third 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) Side-effects were
not reported in this study (33). No data are available describing the relative infant dose of shatavari
after breast milk consumption (34).

Xiong-gui-tiao-xue-yin: A small study in 82 women indicated that the use of the traditional Japanese
herbal medicine Xiong-gui-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 were provided on the wellbeing of the infants (35).

Others: Any herbs that might have hormonal effects, e.g. chasteberry (also known as agnus castus)
should be avoided during lactation. Chasteberry can suppress the release of prolactin in women with
hyperprolactinaemia (12,18).

Similarly, alfalfa (12) and fennel (13) have oestrogenic properties. Theoretically, therefore, these
herbs could inhibit breast milk production. Neurotoxicity (hypotonia, lethargy, vomiting, weak cry and
poor sucking) has been reported in two breastfed infants whose mothers drank a herbal tea that
included fennel, liquorice, goat's rue and anise (36).

Overall, there is not enough available information to support the medicinal use of, anise, chasteberry,
alfalfa, fennel, borage, blessed thistle, milk thistle, goat’s rue, dill, caraway or asparagus in nursing
mothers (12,26,31). The use of galactagogues (mainly non-herbal) has been reviewed in the UKMi
Q&A ‘Drug treatment of inadequate lactation’ (37).

Herbs which decrease milk supply

Sage is thought to reduce a lactating mother's milk supply (12). Some recommend using it during the
process of weaning (18,38). Chasteberry constituents can inhibit prolactin release (12), and milk
production (18). Other herbs reported to decrease milk supply include peppermint (18,38), spearmint,
parsley (18,38), chickweed, black walnut, stinging nettles, yarrow, Herb Robert, lemon balm, oregano,
periwinkle herb, and sorrel (38). For all these herbs, there is insufficient evidence of safety in
lactation, particularly when used in amounts that are greater than would be found in foods (12,30). In
the case of periwinkle, one source indicates that it is unsafe when taken orally, so use should be
avoided during lactation (12).

Management of post-natal depression

The management of depression with complementary medicines, including St John’s Wort, valerian
and gingko biloba has been reviewed in the UKMi Q&A ‘Management of depression in breastfeeding
mothers – Are St John’s Wort and other complementary therapies safe?’ (39).

Other commonly used herbs

Black cohosh: No data are available on the transfer of black cohosh into breast milk (13). In addition,
black cohosh could have oestrogenic and/or antioestrogenic activity (40). Since black cohosh might

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negatively affect breast milk production due to its oestrogenic effects (13), it should be avoided during
lactation until further information is available (12).

Coenzyme Q10: It is likely that coenzyme Q10 passes into breast milk (13). Because of the lack of
safety data, it is recommended that coenzyme Q10 is avoided by breastfeeding mothers (12,13).

Echinacea: Tinctures of echinacea can contain high amounts of alcohol which would be
contraindicated in nursing mothers (15). Although it is generally well tolerated, allergic reactions are
possible with echinacea (15). It is not known whether echinacea transfers into breast milk or affects
lactation (13). Due to a lack of safety data one source advises avoiding echinacea when
breastfeeding (12). In general echinacea should be used with caution until there is further evidence to
support its safety (41).

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 (15).

Ginseng (Panax): Scientific evidence to support the use of ginseng (Panax) during breastfeeding is
not available (30). As a result, one source suggests that use during breastfeeding is avoided (12).
There is conflicting information as to whether ginseng has oestrogenic effects (1242). Oestrogens are
known to suppress breast milk production.

Turmeric: There is insufficient information available on the safe use of medicinal quantities of
turmeric during breastfeeding (1230). One source suggests that the risk of adverse effects is low but
that use should be minimised if either the mother or infant are taking prescription medicines (13),
Further information on adverse effects and interactions with turmeric is provided in the UKMi Q&A
'Turmeric: potential adverse effects and interactions' (43).

Practical Information
Although it is not currently recommended, if a breastfeeding woman does decide to take a 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 a 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.
 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.
 If a 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.

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 Healthcare professionals should take into consideration why a woman wishes to take a 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 a
herbal medicine is safe to use in breastfeeding.

References
1. 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.
2. Sim TF, Sherriff J, Hattingh HL, et al. The use of herbal medicines during breastfeeding: a
population-based survey in Western Australia. BMC Complement Altern Med 2013;13:317.
3. Bettiol A, Lombardi N, Marconi E, et al. The use of complementary and alternative medicines
during breastfeeding: results from the Herbal supplement in Breastfeeding Investigation
(HaBIT) study. Br J clin Pharmacol 2018;84:2040-7.
4. Grzeskowiak LE, Hill M, Kennedy DS. Phone calls to an Australian pregnancy and lactation
counselling service regarding use of galactagogues during lactation – the MotherSafe
experience. Aust NZJ Obstet Gynaecol 2018;58:251-4.
5. NHS Choices. Herbal Medicines. Page last reviewed: 23/11/2018. Available from:
https://www.nhs.uk/conditions/herbal-medicines/ [cited 23/4/2019]
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. Madge I, Cramer L, Rahaus, et al. Pyrrolizidine alkaloids in herbal teas for infants, pregnant
or lactating women. Food Chemistry 2015;187:491-8.
10. BfR (2013) Pyrrolizidine alkaloids in herbal teas and teas. Opinion No. 018/2013 or the BfR
from 5 July 2013. Berlin 8Germany): Bundesamt fur Risikobewertung.
11. 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.
12. Natural Medicines (online). Somerville (MA): Therapeutic Research Center; 2019 [cited
28/3/2019, 1/4/2019,16/4/2019 and 23/4/2019]. Available from:
https://naturalmedicines.therapeuticresearch.com/
13. Hale’s Medications and Mothers’ Milk [Internet]. New York: Springer Publishing Company
[cited 25/3/2019, 9/4/2019 and 11/4/2019]. Available from: https://www.halesmeds.com/login
14. Briggs GG, Freeman RK, Towers CV, et al. Drugs in pregnancy and lactation. Philadelphia:
Walters Kluwer; 2017 [cited 25/3/2019 and 11/4/2019]. Available from:
15. Conover E and Buehler BA. Use of herbal agents by breastfeeding women may affect infants.
Pediatr Ann. 2004;33:235-40.
16. Rouse D. Herbs to be avoided during lactation (AltMedDex® Consult). In: IBM Micromedex®
Alternative Medicine (electronic version). Truven Health Analytics, Greenwood Village,
Colorado, USA. Available at: http://www.micromedexsolutions.com/ (cited: 25/4/2019).
17. Uslu S, Bulbul A, Diler B, et al. Urticaria due to Urtica dioica in a neonate [abstract]. Eur J
Pediatr. 2011;170:401-3.
18. Lawrence R and Huttel E. Alternative remedies, vitamins, and minerals. In: Schaefer C,
Peters P, Miller RK, editors. Drugs during pregnancy and lactation. Treatment options and
risk assessment. 3rd ed. London: Elsevier BV; 2015. p.803-11.
19. What is a galactogogue? Do I need one? Kellymom breastfeeding and parenting web site.
Available from: https://kellymom.com/bf/can-i-breastfeed/herbs/herbal_galactagogue/ [cited
11/04/19].
20. The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use
Available through Specialist Pharmacy Service at
www.sps.nhs.uk
 Medicines Q&As

of Galactagogues in Initiating or Augmenting the Rate of Maternal Milk Secretion. Breastfeed

Med. 2011;6:41-9
21. Low Dog T. The use of botanicals during pregnancy and lactation. Altern Ther Health Med.
2009;15:54-8.
22. 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.
23. Reeder C, LeGrand A, O’Connor-Von SK. The effect of fenugreek on milk production and
prolactin levels in mothers of preterm infants. Clinical Lactation 2013;4(4): 159-165.
24. Khan TM, Wu DB-C, Dolzhenko AV. Effectiveness of fenugreek as a galactagogue: A network
meta-analysis. Phytother Res 2017;1-11.
25. Dougherty RM and Mazurkiewicz R. The dangers of herbal supplements: a case of acute liver
injury from fenugreek. Abstracts from the 2018 Society of General Internal Medicine Annual
Meeting.
26. 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.
27. Tiran D. The use of fenugreek for breast feeding women. Complement Ther Nurs Midwifery.
2003;9:155-6.
28. Di Pierro F, Callegari A, Carotenuto D, et al. Clinical efficacy, safety and tolerability of BIO-C®
(micronized Silymarin) as a galactagogue. Acta Biomed 2008;79(3):205-10.
29. Zapantis A, Steinberg JG, Schilit L. Use of herbals as galactagogues. J Pharm Prac
2012;25(2): 222-31.
30. Monograph. In: IBM Micromedex® Alternative Medicine (electronic version). Truven Health
Analytics, Greenwood Village, Colorado, USA. Available at:
http://www.micromedexsolutions.com/ (cited: 2/4/2019, 11/4/2019, 16/4/2019 and 23/4/2019).
31. 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.
32. Joglekar GV, Ahuja RH, Balwani JH. Galactogogue effect of Asparagus racemosus.
Preliminary communication. Indian Med J. 1967;61:165.
33. 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;10:167-72.
34. Forinash AB, Yancey AM, Barnes KN, et al. The use of galactogogues in the breastfeeding
mother. Ann Pharmacother 2012;46:1392-404.
35. 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.
36. Rosti L, Nardini A, Bettinelli ME, Rosti D. Toxic effects of a herbal tea mixture in two
newborns. Acta Paediatrica. 1994;83:683.
37. UKMi Q&A 73.4: Drug treatment of inadequate lactation. Available from:
https://www.sps.nhs.uk/articles/drug-treatment-of-inadequate-lactation/ [cited 25/4/19].
38. Too much milk: sage and other herbs for decreasing milk supply. Kellymom breastfeeding
and parenting web site. Available from: http://kellymom.com/bf/can-i-breastfeed/herbs/herbs-
oversupply/ [cited 23/4/2019].
39. UKMi Q&A 254.3: Management of depression in breastfeeding mothers – Are St. John’s Wort
and other complementary therapies safe? Available from:
https://www.sps.nhs.uk/articles/management-of-depression-in-breastfeeding-mothers-d-are-
st-johnos-wort-and-other-complementary-therapies-safe/ cited 25/4/2019]
40. 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.
41. 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:e262-e267.
42. 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.
43. UKMi Q&A: Turmeric: potential adverse effects and interactions. Available from:
https://www.sps.nhs.uk/articles/turmeric-potential-adverse-effects-and-interactions/ [cited
7/5/19].

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Quality Assurance
Prepared by
Alex Bailey, Welsh Medicines Information Centre

Date Prepared
20th May 2019

Checked by
Gail Woodland, Welsh Medicines Information Centre

Date of check
23rd May 2019

Search strategy
 Embase ([herbal medicine OR exp medicinal plant] AND [breast milk OR lactation OR breast
feeding]
 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]
 PubMed ((breast feeding [MeSH Terms]) OR lactation[MeSH Terms] OR milk, human[MeSH
Terms]) AND (plants, medicinal[MeSH Terms]) OR drugs, chinese herbal[MeSH Terms]) OR
herbal medicine[MeSH Terms]) OR phytotherapy[MeSH Terms])) OR (("breast feeding" OR
breastfeeding) OR lactation) AND herb). Filters: Publication date from
 NICE Evidence(“herbal medicines” AND breast)
 Micromedex (herbal medicine name)
 Natural Medicines Comprehensive Database (herbal medicine name)
 United Kingdom Drugs in Lactation Advisory Service (UKDILAS), Trent and West Midlands
Medicines Information Service.
 Medication and Mothers’ Milk (online) (herbal medicine name)
 Drugs in Pregnancy and Lactation (online) (herbs) (herbal medicine name)
 Drugs during Pregnancy and Lactation, Third Edition (online)
 MHRA (herbal and lactation/breast)

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