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Medications and Breastfeeding

from LEAVEN, Vol. 33 No. 2, April - May 1997, pp. 39-41
by Pat Sturges
Sedalia, Missouri, USA

We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time

As more mothers choose breastfeeding as the way to nourish their infants, questions about taking medications while breastfeeding are on the rise. Indeed, many breastfeeding mothers receive medication during the first week postpartum. Even though most medications given to breastfeeding mothers pass into the mother's milk, the majority of over-the- counter and prescription drugs are considered compatible with breastfeeding.

Often, answering questions about the safety of a medication is not as easy as mothers sometimes think. Evaluating the safety of a medication for an individual mother and baby is complex and needs to be done by a licensed medical professional. The good news is that Leaders can help mothers with questions about medications without giving medical advice. Leaders can discuss drugs in general and their effects on the breastfeeding baby and mother.

First, some information is needed about the baby and the mother:

What is the age of the baby? The younger the baby, the less able he is to eliminate a drug from his system. A full-term newborn can metabolize a drug easier than a premature baby, but is less able to metabolize a drug than an older baby. At about two weeks of age, the full-term baby's liver is mature enough to metabolize most drugs.

What is the baby's weight? The more the baby weighs, the less likely he will be affected by a drug, as drug doses in children are usually calculated by weight.

How much human milk is being consumed? A baby who is exclusively breastfed will receive more of a drug than a baby who is receiving solid foods as well. A toddler who receives more nourishment from food than from breastfeeding would receive even less of a drug.

What is the general health of the baby? Is the baby full-term or premature? Does he have any illnesses or health problems?

What is the nature of the mother's illness? It helps to get as much information as possible from the mother regarding her medical problem, including what her health care provider may have said.

Next, some general information about the drug in question should be reviewed. First, ask the mother for the name of the medication, the dosage and the duration of therapy. Ask her to spell the name of the drug for you and give the generic name if possible. The mother may want to consider discussing the following questions with her health care provider:

Has the drug been given to infants? A drug commonly prescribed for infants is usually a good choice for a breastfeeding mother.

Has the drug been given to other nursing mothers? A drug that has a history of use by nursing mothers is a better choice than a new, possibly untested drug.

What is the duration of the drug therapy? The duration of the drug therapy can affect its compatibility with breastfeeding. A drug considered compatible with breastfeeding when taken for a few days may not be compatible when taken over a long period of time.

Is the drug short-acting? A short-acting form of the drug may be a better choice for a breastfeeding mother than a longer-acting form that stays in the mother's system for a longer period.

How is the medication being given? A drug given by injection or by mouth is less concentrated than one given intravenously. However, a drug may be given intravenously because it is inactivated or not absorbed by the digestive system, so the baby's digestive system would also inactivate or not absorb the drug.

How well can the baby excrete the drug? Some drugs accumulate in a baby's system and can potentially build to toxic levels. A drug that is quickly eliminated by the baby is more compatible with breastfeeding.

Does the drug interfere with lactation? Some drugs should be avoided by breastfeeding mothers because they affect breastfeeding itself (the let-down or milk supply).

A number of resources on drugs and breastfeeding have been published. The American Academy of Pediatrics (AAP) list that is reprinted in the BREASTFEEDING ANSWER BOOK is good for a quick reference but offers a limited amount of information. Not every drug available in a particular classification is listed, nor is the dosage or frequency. Drug reference books compiled by drug companies need to be used with caution. They are influenced by legal liability and the information is usually overly cautious. Medical literature relating specifically to breastfeeding offers more complete information on specific drugs. It is often a good idea to check more than one written resource as information is sometimes conflicting.

When giving information about a specific drug from a written resource, read it verbatim, without personal opinion or interpretation. To do otherwise would be considered giving medical advice.

Based on information from Philip O. Anderson, Pharm D, the following steps can be used to minimize infant exposure to drugs in human milk with minimal disruption of breastfeeding. A mother may want to discuss these options with her health care provider.

Delay the therapy If the drug or surgery is elective, a mother may be able to delay it until the baby is weaned. Choose drugs that pass poorly into milk. There can be differences within classes of drugs regarding the amount that enters the milk. Choose an alternative route of distribution. For example,. an inhalant instead of a drug taken by mouth, or a topical application rather than oral dosing, would reduce infant exposure. Coordinate breastfeeding with medication schedule to minimize exposure. A mother can avoid breastfeeding when the concentration of the drug is at peak levels or she can take a dose before baby's longest sleep period. Temporarily withhold nursing. If a drug is to be taken for diagnostic testing (such as a radioactive agent) a mother may need to withhold breastfeeding for a short period of time, pumping and discarding her milk. Discontinue breastfeeding. This is a last resort but may be necessary for the health and well-being of the mother, for example if she needs chemotherapy or radioactive treatment.

In addition, the American Academy of Pediatrics (AAP) recommends the following:

Monitor baby's reaction while mother is taking a questionable drug.

The reasons why mothers call La Leche League about medications are varied. A mother may not have told her health care provider that she is breastfeeding out of fear of causing conflict. She may realize after she gets home that she has additional questions. She may have been told that she must discontinue breastfeeding in order to take a medication. She may have been told that a medication is compatible with breastfeeding but she is double-checking for her own peace of mind. Maybe she has not yet seen her health care provider but is anticipating that a certain medication will be prescribed.

No matter what a mother's reasons, our responsibility as Leaders is to provide information and support. A mother may need help exploring her feelings about what she really wants to do. A Leader can help a mother verbalize her feelings about the importance of the breastfeeding relationship to her health care provider. She can help her formulate questions to ask him/her. Encouraging a mother to work openly with the health care provider can empower her to do what's best for herself and her baby.

Ed. Note: Leaders with additional questions can contact their local Professional Liaison Leader.

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