September 11, 2013
Pediatrics Group Recommends On-Line Resource for Lactation Drug Safety Questions

Elk Grove Village, IL—Nursing mothers have lots of questions and concerns about what therapeutic drugs are safe to use. Now, pharmacists have an easy-to-access resource to help answer their questions and make sure they don’t unnecessarily suspend needed medications.

A new report from the American Academy of Pediatrics (AAP) notes that, “Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants.”

For the most current and comprehensive information, the AAP recommends that health care professionals go to LactMed on the Internet. A mobile application also is available.

LactMed is part of the National Library of Medicine’s Toxicology Data Network, and each record includes information such as:

• The generic name: refers to U.S.-adopted name of active portion of the drug;
• The scientific name: genus and species of botanical products (when applicable);
• The summary of use during lactation (includes discussion of conflicting recommendations and citations);
• Drug levels, including maternal levels based on studies that measure concentration in breast milk and relative infant dose (weight-adjusted percentage of maternal dose) when possible, and infant levels, including serum or urine concentrations from the literature;
• Effects in breastfed infants, including adverse events with Naranjo assessment of causality—definite, probably, possibly, unlikely;
• Possible effects on lactation, including effects on infants that may interfere with nursing, e.g., sedation; and
• The last revision date.

“Although most drugs and therapeutic agents do not pose a risk to the mother or nursing infant, careful consideration of the individual risk/benefit ratio is necessary for certain agents, particularly those that are concentrated in human milk or result in exposures in the infant that may be clinically significant on the basis of relative infant dose or detectable serum concentrations,” according to the recently published report from Hari Cheryl Sachs, MD, FAAP, of the AAP’s Committee on Drugs. “Caution is also advised for drugs and agents with unproven benefits, with long half-lives that may lead to drug accumulation, or with known toxicity to the mother or infant. In addition, specific infants may be more vulnerable to adverse events because of immature organ function (e.g., preterm infants or neonates) or underlying medical conditions.”

The AAP recommends that “consultation with a specialist may be indicated, particularly when the use of radiopharmaceuticals, oncologic drugs, or other therapies not addressed by LactMed is contemplated.”

The recent report also discusses other issues related to lactation such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women.

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