portaladmin posted on August 27, 2009 09:31
by Philip O. Anderson, Pharm.D., FASHP, FCSHP
Breastfeeding is acknowledged as the standard against which other methods of infant feeding are judged. No artificial feeding method comes close to providing the benefits of breastfeeding in terms of infant and maternal health. All major national and international healthcare organizations with policy statements on breastfeeding recommend exclusive breastfeeding for 6 months with continued breastfeeding thereafter.
Sometimes nursing mothers need a medication. Almost any medication will reach the breastmilk in some quantity. However, the amount that appears in milk is usually not great enough to harm a nursing infant. One group or researchers found that 87% of drugs are transmitted in amounts of 10% or less of the mother’s dose. About half of these are in amounts less than 1% of the mother’s dose. Only about 3% of drugs reach the infant in amounts similar to the mother’s dose.
Infant age is often the major determinant of the safety of maternal medication use during breastfeeding. The infant’s ability to metabolize and detoxify foreign chemicals and drugs improves with time. Premature infants have little ability to metabolize drugs. The amount of medication in a mother's milk that is safe for a one-month-old might pose a risk for a premature infant. Likewise, a baby who is several months old has a much greater drug metabolic capability than a one-month-old. And when an infant begins to eat solid food, breastmilk consumption decreases and, so therefore, does the infant dose of any medication the mother is taking. Almost no adverse reactions have been reported from medications in breastmilk in infants over 6 months of age, the age when complementary foods should be introduced.
Unfortunately, information on medication safety during breastfeeding is often inaccurate. Unnecessary alarm and confusion is often caused by statements concerning nursing made by a drug’s manufacturer in the Physician’s Desk Reference (PDR) or package insert. This information, in turn, is repeated in many databases, books, and review articles, further exacerbating the problem. Too often this inaccurate information leads to mothers discontinuing breastfeeding unnecessarily. The U.S. Food and Drug Administration has acknowledged this problem and has proposed new and greatly improved standards for lactation information in the package insert. However, the process of changing labels of all marketed medications will take many years.
More accurate and complete information on medications during breastfeeding can be found on the U.S. National Library of Medicine’s LactMed web site. The URL for this site is http://lactmed.nlm.nih.gov. Although the information on this site is mostly aimed at health professionals, the summary is understandable by nursing mothers. Also, you can email the counselors at CTIS Pregnancy Risk Information Line at http://ctispregnancy.org/EmailaCounselor. CTIS counselors have access to this source and many others as well as experience in answering questions on medications during breastfeeding.