I wrote last month about the availability of a free app from Lactmed, the similarly free website from the NIH, to help prescribers and mothers determine whether a medication is safe for breastfeeding.
Now Dr. Thomas Hale, author of the bible on this topic, "Medications and Mother's Milk" (aka "MMM") is coming out with an app version called InfantRisk, also for iPhone and Android. If you've ever used "MMM", you know what an amazing reference it is. Dr. Hale classifies drugs into 5 levels of risk category, from L1 (Safest) to L5 (Contraindicated), provides an extensive monograph on each, provides information such as time to peak plasma level in the blood (so a mother could time feedings/pumping around those peak times), and includes a lot of herbal and OTC meds that Lactmed does not.
Watching this video of the app, I was really impressed by how they've put a lot of value added into the app, even going beyond the information available in the book. "InfantRisk" really is the better term for this app, as each drug now has safety information for not only different stages of breastfeeding, but also for each trimester of pregnancy. You can also search based on specific patient parameters, set bookmarks, and get updates from the InfantRisk Center. There's also a quick way to call the InfantRisk Center for questions that you're still unsure about.
This app isn't free, and compared to other apps that I'm used to purchasing (usually $1.99, maybe $4.99 for something great that I'll use a lot) it's a pretty hefty price tag at $29.99. But after I saw the video, I realized it's a great deal for anyone who would otherwise purchase "MMM". For less than the price of the book ($36 on Amazon), you get the same information PLUS a lot of added functionality. With the pregnancy safety info, it would especially be a great investment for an obstetrician, midwife, or family practitioner who would use it both pre- and postnatally. I probably won't purchase it this second, as my work has the latest edition of "MMM", but I'll probably get it eventually for the convenience of having an updated reference at my fingertips. And also 'cause it looks so snazzy!
And don't forget that if you're not looking to invest in the app or the book, but have questions that aren't answered by a free resource like LactMed, anyone can call the InfantRisk Center helpline. They're available Monday-Friday, 8am-5pm central time: (806)-352-2519.
Showing posts with label medications. Show all posts
Showing posts with label medications. Show all posts
Wednesday, July 20, 2011
Saturday, June 18, 2011
How safe is your medication for breastfeeding? New LactMed app!
NOTE: Previously the LactMed app was not available on the Android Market - you had to go to the LactMed website to download it. It is now available on the Market directly - just search "LactMed".
I was talking to a doctor recently about a woman who is breastfeeding and newly diagnosed with a chronic health condition. The doctor said, "I want to prescribe her Drug Y, but she couldn't take that when she's breastfeeding, right?" Since the answer to "can she take that when breastfeeding" is almost always "yes", I suspected it was fine, and I made it a teachable moment. "I don't know, but I know how you can find out!" I said. I opened the LactMed website, typed in the drug, and voila! It was of minimal concern for a breastfeeding dyad, and I had spread knowledge about this resource to one more person.
I have written about the issue of breastfeeding and medications before and mentioned LactMed as an easily accessible, free resource from a very trusted source (the NIH). Now the exciting news is that LactMed is being made available as a free app for iPhones and Android phones. This is a fantastic addition as many doctors use apps to aid in prescribing, and some of the most popular apps like ePocrates and Micromedex are not nearly as comprehensive and accurate about breastfeeding information as they should be (check out this chart to see how widely varied different sources can be for the same list of commonly prescribed drugs.) Having a more accurate app on the screen right next to the prescribing app - instead of a website that you need to go and access - will hopefully help increase use of LactMed as a resource.
When doctors think they can't prescribe a drug for a breastfeeding woman, one of two things happens: 1) The baby is weaned early (sometimes very early) and unnecessarily, or 2) The woman is not treated because the doctor doesn't even offer the drug, or because when she is told she has to choose between breastfeeding and treatment, she chooses breastfeeding and - again unnecessarily - postpones or forgoes treatment. Do you know a doctor, pharmacist, or NP/CNM? Let's prevent these scenarios by spreading the word about an easy and accurate resource for medication safety!
I was talking to a doctor recently about a woman who is breastfeeding and newly diagnosed with a chronic health condition. The doctor said, "I want to prescribe her Drug Y, but she couldn't take that when she's breastfeeding, right?" Since the answer to "can she take that when breastfeeding" is almost always "yes", I suspected it was fine, and I made it a teachable moment. "I don't know, but I know how you can find out!" I said. I opened the LactMed website, typed in the drug, and voila! It was of minimal concern for a breastfeeding dyad, and I had spread knowledge about this resource to one more person.
I have written about the issue of breastfeeding and medications before and mentioned LactMed as an easily accessible, free resource from a very trusted source (the NIH). Now the exciting news is that LactMed is being made available as a free app for iPhones and Android phones. This is a fantastic addition as many doctors use apps to aid in prescribing, and some of the most popular apps like ePocrates and Micromedex are not nearly as comprehensive and accurate about breastfeeding information as they should be (check out this chart to see how widely varied different sources can be for the same list of commonly prescribed drugs.) Having a more accurate app on the screen right next to the prescribing app - instead of a website that you need to go and access - will hopefully help increase use of LactMed as a resource.
When doctors think they can't prescribe a drug for a breastfeeding woman, one of two things happens: 1) The baby is weaned early (sometimes very early) and unnecessarily, or 2) The woman is not treated because the doctor doesn't even offer the drug, or because when she is told she has to choose between breastfeeding and treatment, she chooses breastfeeding and - again unnecessarily - postpones or forgoes treatment. Do you know a doctor, pharmacist, or NP/CNM? Let's prevent these scenarios by spreading the word about an easy and accurate resource for medication safety!
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!
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!
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