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.
Page last edited Sun Oct 14 09:31:57 UTC 2007.
