This section covers medications commonly used in conducting gastrointestinal procedures, such as endoscopy (including upper endoscopy, colonoscopy, and sigmoidoscopy) and barium swallow studies. For information on commonly used over-the-counter medications for gastrointestinal illnesses, please see the section on Over the Counter Medications. For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

In general, there is no absolute indication to pump and dump after Colonoscopy, Endoscopy and Barium swallow or with most medications used during these procedures.¹ The following recommendations are suggested for lactating women requiring procedures and surgeries based on general information from the American Society of Anesthesiologists:²

1. Anesthetic Medications: All anesthetic medications transfer to breastmilk. However, only small amounts are present in breastmilk in very low concentrations that are considered clinically insignificant. Patients can resume breastfeeding or pumping as soon as they are alert and able to do so after surgery because anesthetic medications appear in such low levels in breastmilk. For information on specific anesthetic agents, particularly any agents of concern, please see the article on Anesthesia.
2. Analgesic Medications: All analgesic medications transfer to breast milk. Pain medications should be used to manage postoperative pain in lactating parents because pain interferes with successful lactation and breastfeeding. Despite an excellent safety record, lactating parents who require narcotic pain medicines should always watch the baby closely for signs of sedation or slow respiratory rate. For more information on specific analgesic agents, particularly any agents of concern, please see the article on Pain Medications.

Barium sulfate is a radiographic contrast agent used in X-ray examination of the gastrointestinal tract, Barium sulfate is not absorbed after oral or rectal administration nor is it metabolized in the body, so it cannot be excreted in breast milk or reach the infant. After radiographic examination with barium sulfate no interruption of lactation is necessary as described in LactMed and e-lactancia. There is no absolute indication to pump and dump.

This section first discusses medications used for conscious sedation during endoscopy. It then reviews medications specific to upper endoscopy (EGD) and lower endoscopy (colonoscopy and sigmoidoscopy).

Medications used for conscious sedation during upper and lower endoscopy have a rapid onset and short duration of action and do not cause major side effects. Commonly used agents include opiates (such as fentanyl), benzodiazepines (such as midazolam or diazepam), and hypnotics (such as propofol).³ There is no absolute indication to pump and dump once the parent is alert enough to pump or directly breastfeed. For more information specific medications, please see the article on Anesthesia.

Nitrous oxide may be used as an adjunctive sedative agent with endoscopy procedures. Nitrous oxide is eliminated extremely quickly and should not impact the breastfeeding infant.¹ This is not an absolute indication to pump and dump.

Patients undergoing upper endoscopy are typically placed in conscious sedation for the procedure. Certain adjunctive medications are used commonly during upper endoscopy to help reduce the gag reflex and help with secretion management.

Topical anesthetics, such as lidocaine, may be used to decrease the gag reflex and facilitate placement of the endoscopy tube. These are large, polarized molecules that do not transfer easily into breastmilk and are not well absorbed via the oral route.^1,4,5 There is no absolute indication to pump and dump.

While there are theoretical concerns regarding milk production and safety during lactation with chronic use of scopolamine, there is no absolute indication to pump and dump with the brief use of scopolamine for conscious sedation. For more information on scopolamine and lactation, please see the section on Anesthesia.

Lower endoscopy includes both colonoscopies (which look at the entire colon) and sigmoidoscopies (which only look at the sigmoid colon).

Enemas for sigmoidoscopies are considered safe during lactation. There is no absolute indication to pump and dump.

Bowel preps are used to clean out the colon before colonoscopies. Some people can become dehydrated as the bowel prep, which is consumed over several hours before the procedure, is not absorbed by the intestine. In general, lactating individuals should talk to their gastroenterologists about ways to stay adequately hydrated while doing a bowel prep. There is no absolute indication to pump and dump.

Bisacodyl is not absorbed from the gastrointestinal tract, and its active metabolite, which is absorbed, is not detectable in breastmilk. Bisacodyl exposure to the infant is negligible.⁶ There is no absolute indication to pump and dump.

Magnesium does not concentrate in breastmilk. Its concentration in milk is very stable and oral or intravenous magnesium does not significantly raise the magnesium level in breastmilk.^6,7  Various medical associations and expert consensus consider the use of various magnesium salts to be safe during breastfeeding. ^8–10 There is no absolute indication to pump and dump.

PEG (Miralax, Movicol, GoLytely, CLyte, NuLytely,TriLyte, Halflytly, MoviPrep) is a saline laxative which is not absorbed from the intestine and does not transfer into breastmilk. Experts, scientific associations, and the manufacturer consider the use of PEG compatible with lactation.^9,11,12  This is no absolute indication to pump and dump.

Sodium picosulfate (Picolax, Prepopik, Clenpiq) is a stimulant laxative not absorbed from the GI tract and its active metabolite, which is absorbed, is not detectable in breastmilk per LactMed and e-lactancia. This medication is also authorized for use in infants from age one month old. There is no absolute indication to pump and dump.

Phosphate from sodium phosphate bowel preps (Clenpiq, Suprep, Prepopik, Visicol, OsmoPrep, Sutab ) can be absorbed when given orally or rectally.¹⁰ Data on breastmilk phosphate levels after these preps is limited and the change in phosphate levels in breastmilk may be as high as 35% after an enema.  Because the changes in phosphate levels from the use of sodium phosphate bowel preps are not well defined, alternatives are preferred if the infant has a condition, such as chronic kidney disease, where changes in breastmilk phosphate levels may impact the infant’s health. While special considerations exist for infants with certain conditions, there is no absolute indication to pump and dump.