It is often observed that in many cases it if found written on prescribing information that the drug is contraindicated in breast feeding mothers, while if you see the route of excretion for that particular agent is either renal, bile etc. What is the logic behind ?
Prescribing info may automatically say do not use when breastfeeding because most medications are not tested on lactating women. Drug company does not wan to take any risks so says do not use.
A drug may go through the milk and be absorbed by the baby (usually in minute amounts), see http://www.infantrisk.com/content/drug-entry-human-milk
However a drug may also inhibit milk production or oxytocin release (milk ejection) though having no affect on the baby or maybe not even getting into the milk. See intro pages in http://www.who.int/maternal_child_adolescent/documents/55732/en/
Most medications have this disclaimer because there are not sufficient studies to verify its safety in a vulnerable population such as mothers and babies.This statement is there to decrease liability. So, it may actually not be unsafe, the risk is just unknown.
Another reason is that some medications while not harmful to the baby, are actually contraindicated to the process of lactation. For example, Estrogen is known to lower breast milk production. Therefore, it is contraindicated in lactation.
The reason is we exactly don't know if it is excreted in milk or else it would be safe.
Excretion in milk is not the only criteria. The baby may not absorb the drug, for example if the molecules are too big. Or the drug may be absorbed but in quantity too small to have any effect on the baby. For most conditions there are treatments that can be used that do not pose a risk to the baby via mother's milk.
However we do know there are many risks from use of non-human milk for infants. These risks need to be considered when talking about any medication risks.
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