A new report, published online on August 26 in the journal Pediatrics, should ease the fears of many women who believe they must avoid or discontinue breastfeeding because they take prescription medications. The report, prepared by Hari Cheryl Sachs, M.D., a pediatric and maternal health expert at the Food and Drug Administration (FDA), notes that many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants.
The report notes that this cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated (not recommended) for breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed; however, may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk; however, more current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary discontinuance of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication.
The FDA report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies (treatment for psychiatric diseases), drugs to treat substance abuse, narcotics, galactagogues (substances that promote milk production in humans and other animals), and herbal products, as well as immunization of breastfeeding women. Dr. Sachs notes that a discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of the report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (www.who.int/topics/breastfeeding/en/).
Take home message:
If you are taking—or have been prescribed—a prescription medication and are breastfeeding, log on to LactMed and look up the drug. Then discuss taking the medication with all healthcare professionals involved in your care. Be aware that all prescription medications can have possible side-effects for you and/or your child. Thus, no medication can be deemed to be completely safe for either of you and the benefits vs. risks must be carefully weighed.