1.8 Medications
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![]() Key Points - Case Study AJoanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal. Would you discuss breastfeeding at this visit?
What information would you give?
Why do breastfeeding alternatives have different effects?
What are mothers' common and valid concerns about breastfeeding?
Would you examine her breasts at this visit?
What are the contraindications to breastfeeding?
What conditions may be related to poorer lactation outcomes?
Joanne's sister-in-law developed hyperthyroidism when she had been breastfeeding her last baby and was told that she would have to wean so that she could commence taking medication. Joanne asks you whether it is common for women to have to wean to be treated for medical conditions. What would you tell her about medication use in breastfeeding women?
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Joanne's sister-in-law developed hyperthyroidism when she had been breastfeeding her last baby and was told that she would have to wean so that she could commence taking medication. Joanne asks you whether it is common for women to have to wean to be treated for medical conditions. What would you tell her about medication use in breastfeeding women?
There are very few medical conditions for which a mother needs to cease breastfeeding so that she can be adequately treated. Within most classes of drugs, or drugs used to treat a specific condition some are better options for breastfeeding women than others. In nearly all situations a mother can continue to breastfeed while she is on medication. Medications that are absolute contraindications to breastfeeding have been mentioned above.
Has the infant already been exposed in-utero? | An infant is exposed to much higher levels of a medication in-utero than through breast milk. |
Is the medication necessary? | Can a topical or local preparation be used rather than an oral or parenteral preparation? |
How much of the drug would the infant receive in a day? What is the relative infant dose? | As a rough guide a relative infant dose of 10% is deemed to be compatible with breastfeeding.
Consider the following:
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Is this medication used in infants? | |
What is its oral bioavailability? | Medications given parenterally to the mother are unlikely to be absorbed by the infant no matter how much is present in breast milk. |
How effective will the infant be excreting what has been absorbed? | Newborns have 33% of the adult capacity for drug excretion while a 7 month old has a similar capacity to an adult. Infants who are premature or sick have reduced capacity. |
Are there other drugs that will be just as effective but are potentially a safer option for a breastfeeding woman? |
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![]() The amount of drug transferred into milk will depend on the dose, timing and formulation of the medication
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Obtaining correct and up-to-date information
Recommendations that a mother should not breastfeed while taking a specific medication are common when limited data is available.
Generic sentences such as “"Drug A is excreted into breast milk and caution should be used when administered to breastfeeding women"
” or “"Alternative feeding arrangements should be considered"
” are often encountered in product information sheets although recommendations often vary between different references.
A recent survey of 10 frequently used sources of information regarding breastfeeding and medication use found wide disparity in the recommendations between the sources for 14 medications1.
Using a reference or source with expertise in evaluating the risks of medications in breastfeeding women is essential. The following list is not inclusive, but contains resources that have reputable information and recommendations.
- Click
here to go to the Drugs and Lactation Database. The LactMed database in the menu on the left will be selected. Enter the name of drug or condition you wish to treat. This database will provide information on the drug's transfer into breast milk, adverse effects in infants, and other drugs with a similar action that may be more appropriate to use in breastfeeding women.
- Medications and Mothers' Milk (Hale Publishing 2006)
- Dr Thomas Hale's
Breastfeeding and Medications Forums
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Drug information centres at the local women's hospital
- Queensland – Queensland Drug Information Centre, 07 3636 7098;
- New South Wales – MotherSafe, 02 9382 6539 (1800 647 848 NSW country);
- Victoria – Drug Information Centre, Royal Women's Hospital, 03 9344 2277;
- South Australia – Women's and Children's Hospital, 08 8161 7222;
- Western Australia – Women's and Children's Health Services, 08 9340 2723;
- ACT – Drug Information Canberra Hospital, 02 0624 4333
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![]() Case Study ActivityThink about what your response would be to the scenario presented, write it into the exercise, then submit it and read the suggestions given. |
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Notes
- # Akus M et al. (2007) Lactation safety recommendations and reliability compared in 10 medication resources