Tuesday, February 2, 2010

Breastfeeding & medications

A frequent reason for mothers to be told to stop breastfeeding and/or "pump and dump" is because they are on medications. I hear this is particularly prevalent in emergency rooms - I assume because ER docs get so few opportunities for education, don't know their resources, and need to cover themselves for liability reasons. But many doctors, including regular primary care providers and even people who should be experienced enough with breastfeeding, like pediatricians and OBs, give bad information about breastfeeding while using medications.

This is not, of course, all their fault. As La Leche League notes, "Health care givers often turn to the Physicians' Desk Reference (the PDR) for information about drugs. ... Information in the PDR comes directly from pharmaceutical companies, whose first concern is avoiding liability. When there are no studies that prove beyond a doubt that a drug is safe for nursing mothers, the drug companies must advise against using it while breastfeeding - even if what is known about the drug suggests that there is little cause for concern."

What resources your doctor uses to determine the safety of medication can make a big difference. One study used a list of drugs that were commonly prescribed to breastfeeding mothers, and looked how many were considered safe in frequently consulted resources:

From Akus M, Bartick M. Lactation Safety Recommendations and Reliability Compared in 10 Medication Resources Ann Pharmacother. September 2007;41(9):1352-1360.

As you can see, there are much better resources out there than the PDR! Most frequently recommended is Medications and Mother's Milk by Dr. Thomas Hale (noted as "MMM" in the chart above).

Dr. Hale's book provides extensive information on almost every drug out there, including some herbals. For easy reference, he classifies all drugs by safety level (L1 being the safest, L5 being absolutely contraindicated) A woman and her doctor can use Hale to determine whether the drug is safe, what special conditions might be cause for concern, and alternative medication choices. He also includes pharmacological information like a drug's time to its peak plasma level (so if a mother is taking a drug that peaks at 2 hours, she might take it right before her baby's longest sleep stretch of 4-5 hours, to minimize the amount the baby will get). New editions are issued every couple of years and there will be another coming out in 2010.

If a mother or doctor doesn't have access to Hale, a good alternative is LactMed, run by the Toxicology Data Network of the National Library of Medicine.

Like Hale, it includes an overview of published research on the effects of the drug, medication alternatives, and a summary of recommendations. With so many doctors carrying PDAs and/or smartphones that allow them to access online resources, LactMed is an excellent tool to get quick answers. However, unlike Hale, it doesn't assign a safety level or include more detailed pharmacological information.

If your care provider is concerned about breastfeeding and medication use, keep in mind that they may not have the best resources. Investigate further and bring those resources to their attention! If a mom is taking medication that's potentially of concern, the LCs I'm training with will print out a LactMed reference page, or copy the relevant pages in Hale, and tell moms to bring the info to their primary care providers. That way the woman and her care provider can look at the information together and make a decision with all the facts available.

And remember, the question should not be "Is there any risk at all posed by breastfeeding while taking this drug?" - every drug carries theoretical risks, no matter how slight. Instead the question should be "Does the risk of the drug outweigh the risks of NOT breastfeeding?" Most often, the answer is NO!

1 comment:

Amelinda said...

www.motherisk.org is another good resource for this kind of information, as well as medication and other substances during pregnancy; they're a project run by the Hospital for Sick Kids in Toronto. IIRC their verdict was that there were very few drugs contraindicated while breastfeeding, and they were on the order of anti-psychotics and such.