Comfrey and Breastfeeding

Summary of use during lactation

Comfrey (Symphytum officinalis) herb and leaf contains allantoin and rosmarinic acid; comfrey also contains pyrrolizidine alkaloids. Comfrey preparations have been used topically for pain following episiotomy and cracked, painful nipples, either as aqueous preparations or in creams and ointments.[1-7] Scientific evidence of effectiveness for these indications is minimal. The pyrrolizidine alkaloids in comfrey can cause severe liver damage, liver cancer, mutagenicity, and even death.[8,9] For this reason, the U.S. Food and Drug Administration has banned the sale of oral comfrey products in the United States. Furthermore, most sources consider topical use of comfrey during breastfeeding to be contraindicated.[1,10] If it is used on the skin, it should only be applied to intact skin away from the breast on the smallest area of skin possible, and for a limited duration. It is particularly important to ensure that the infant not come into direct contact with the areas of skin that have been treated, because ingestion may cause severe liver damage. Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. Low DogT. The use of botanicals during pregnancy and lactation. Altern Ther Health Med 2009 15 54 8 19161049 PubMed
2. PetrieKA PeckMR Alternative medicine in maternity care. Prim Care 2000 27 117 36 10739460 PubMed
3. KopecK. Herbal medications and breastfeeding. J Hum Lact 1999 15 157 61 10578793 PubMed
4. AllaireAD MoosMK WellsSR Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000 95 19 23 10636495 PubMed
5. DennehyC TsourounisC BuiL The use of herbs by California midwives. J Obstet Gynecol Neonatal Nurs 2010 39 684 93 21044150 PubMed
6. YarnellE. Botanical medicine in pregnancy and lactation. Altern Complement Ther 1997 3 April 93 100
7. Fleiss P. Herbal remedies for the breastfeeding mother. Mothering 1988;Summer:68-71.
8. PanterKE JamesLF Natural plant toxicants in milk: A review. J Anim Sci 1990 68 892 904 2180885 PubMed
9. WinshipKA Toxicity of comfrey. Adverse Drug React Toxicol Rev 1991 10 47 59 1878443 PubMed
10. HowardCR LawrenceRA Drugs and breastfeeding. Clin Perinatol 1999 26 447 78 10394496 PubMed