Drugs and Breastfeeding

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.

  1. 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.
  2. 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.
  3. If a medication’s safety is questionable, look for an alternative.
  4. 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.
  5. 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?

5 Comments

  1. Jill

    Ibuprofen or other NSAIDs are not something I recommend to pregnant women and should not be used in children under 6 months with some pediatricians recommending avoiding until 12 months of age. NSAID use in the first trimester is associated with an increased risk of miscarriage and fetal malformations and use after 30 weeks increases the risk of premature closure of the fetal ductus arteriosus.

    Reply
    • Eric Christianson

      Thanks for the comment Jill! I would definitely agree with you in pregnancy. Also would agree that patients should seek medical guidance when it comes to using analgesics/antipyretics in infants (peds less than 1 y/o) to ensure that nothing else is going on. With that said, ibuprofen is generally considered safe to use for mom when she is breastfeeding with a few rare exceptions. https://www.drugs.com/breastfeeding/ibuprofen.html

      Reply
      • Muhammad Tariq

        Acetaminophen is also one of the safest Analgesics and antipyretics, acetaminophen drops can be used in neonates.

        Reply
  2. Cole

    Its equally important to not make a mountain out of a mole hill in these situations. There’s a reason Ibuprofen is on every post-partum orderset (excepting an allergy to ibuprofen/NSAIDs). Read the LactMed entry on ibuprofen and you will feel comfortable recommending ibuprofen to every nursing mother where appropriate. Too often we take an unnecessarily hard line against meds, etc in breastfeeding, a phenomenon not exclusive to pharmacists. See the major discordance between Radiology vs OB/GYN guidelines on breastfeeding post IV contrast – clinically minded practitioners come up with reasonable recommendations based on the evidence, while the folks most removed from patient care take an overly conservative (and I’d argue detrimental stance) in the name of ‘playing it safe’.
    Here’s a link to Ibuprofen in LactMed (when checking the math recall exclusively breastfed infants take approximately 150 mL/kg/day of milk): https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~7OHOIa:1

    Reply

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Written By Eric Christianson

October 18, 2017

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