Thursday, February 25, 2010

Drugs and Breastfeeding

The very last compilation of note-worthy information from my Breastfeeding Basics online learning module!

1. There are several references that have compiled data regarding the safety of drugs given to breastfeeding mothers, including the following:
  1. LactMed: A peer reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed.
  2. Breastfeeding: A Guide for the Medical Profession 6th ed. Ruth Lawrence and Robert Lawrence. Appendix D contains a summary table of the effect of maternal medications on the breast fed infant. 
  3. The American Academy of Pediatrics Statement on Drugs and Breast Milk 
  4. Drugs in Pregnancy and Lactation 7th ed. Briggs, Freeman and Yaffe. 
  5. Medications and Mothers' Milk. 13th Ed. 2008, Thomas Hale.
The "Physician's Desk Reference" (PDR), which is used by many people as a source of information on drugs, is not a particularly good reference for the effect of medications on lactation or on the breast fed infant. For most drugs the PDR states that the drug has not been tested in lactating women, (a true statement) and consequently should not be given to lactating women. While this is certainly a safe recommendation, it will result in many women stopping breastfeeding unnecessarily. In most cases, a physician can determine that a woman may safely continue to breastfeed while taking the prescribed medication by checking one of the references given above.

2.  Contraception while Breastfeeding:

- The Lactational Amenorrhea Method (LAM
- The use of the combined estrogen/progestin oral contraceptives can cause decreased milk production in breastfeeding women. Use of the lowest dose estrogen containing pill may help minimize this effect. The effect of the pills on decreasing milk production varies among women and may be transient.
- Progestin only forms of hormonal contraception including pills, depot medroxyprogesterone acetate (Depoprovera) and the etonogestrel implant (Implanon®) have been shown to produce no changes in breast milk composition, breast milk supply, duration of breastfeeding or infant growth.

3. In many countries of the world, herbs or various foods are used to increase milk production. These include fenugreek, goat's rue, milk thistle, beer, papaya, and others. There is little scientific evidence of the efficacy of most of these foods on increasing breast milk production. Fenugreek, which is used as a spice and medicine in India and the Middle East has been the most widely used to increase breast milk supply. Anecdotal reports suggest some efficacy for fenugreek, however this data is very limited. Side effects can include low blood sugar in the mother, maple like odor to sweat, milk and urine, diarrhea and increased asthmatic symptoms.

Many medications can also increase milk production, ie. domperidone, by blocking dopamine receptors and subsequently increasing prolactin levels. Domperidone is not available in the United States. However, studies performed in Canada and Italy show that when Domperidone was given to lactating mothers at a dose of 10 mg three times a day, prolactin levels and milk production increased. There were no reported side effects.

4. Herbal teas considered safe during lactation include Chicory, Orange spice, Peppermint, Rasberry, Red bush tea and Rose hips.

 5. Pain Killers: Use of acetaminophen and ibuprofen are safe and effective in breastfeeding women. Oral codeine and hydroxycodonemay also be used by breastfeeding mothers, but mother should monitor their infants for sleepiness and other behaviors.

6. No Illicit drugs should be used during pregnancy or breastfeeding, including alcohol and marijuana. They all pass into breast milk and affect the baby.

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