Being a primarily geriatric pharmacist, drugs and breastfeeding has been a topic that I have had to learn a lot about to put myself in the best spot to try to help patients when questions come up. As I have gotten more and more questions, I’m ok with the answer of, let me double check that. With that said, there are some basic principles I think about when I’m not sure what to recommend.
- What is the severity of the symptoms requiring a medication? This is an important question to ask. Let’s take heartburn for example. How bad has the heartburn been, and does it actually require medication therapy is the first question I would look to assess. If non-drug interventions haven’t been tried and the symptoms are of mild-moderate severity, that might be the route I would approach first prior to recommending a medication.
- Can the baby take the medication? Use of ibuprofen and acetaminophen is very common in pediatrics for fever and pain. The mother taking these medications periodically for a rare headache or ache/pain will likely not be an issue.
- If a medication’s safety is questionable, look for an alternative.
- In complex situations, work as a team. Getting the perspective of each specialty potentially involved in the mother’s situation is a no-brainer. For example, a psychiatrist may be involved and has known the patient for 10 years; they will have a deep understanding of how important a medication is for the mom’s mental health and well-being.
- How much is passed in the breastmilk to the baby? Many drugs do not enter breastmilk and likely won’t present any issues for the baby.
What other questions would you think about when asked questions about drugs and breastfeeding?