Medications and Breastfeeding Mothers January 22, 2013 16:25

Below are some of my favorite go-to resources for research on Medication Use for Breastfeeding Mothers. 

First, it's important to know how medications are categorized to better decipher the literature.  Below are the Lactation Risk Categories.

L1 SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
L2 SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
L3 MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4 POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
L5 CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Online Drug Databases and Resources

Breastfeeding Pharmacology – Dr. Hale, Professor of Pediatrics, is a renowned Breastfeeding Pharmacologist and the author of Medications and Mothers' Milk

LactMed from the National Library of Medicine-

A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

Here's a shortcut to the massive database - just enter the medication in question below:

 

Drugs in Pregnancy and Breastfeeding– Perinatology.com – has a great list of scholarly and professional resources

Breastfeeding and Maternal Medication- great PDF file with detailed information and summary of research from the World Health Organization

Summary of Antidepressant Use in Breastfeeding Mothers- a keynote address by Thomas Hale, PhD at the LLL of Illinois Area Conference, Bloomingdale, IL, October 23, 2002 - summarized by KellyMom.com

Help Lines

 

Mother Risk(phone 416-813-6780) - at The Hospital for Sick Children in Toronto, Ontario, Canada. Call or visit their website for evidence-based information about the safety or risk of drugs, chemicals and disease during pregnancy and lactation.

Breastfeeding and Human Lactation Study Center at The University of Rochester in Rochester, NY, USA. This center maintains a database of drugs and medications and provides free information to physicians and lactation consultants on their use and effects during breastfeeding. Ruth A. Lawrence, MD is the Director of the center.

Drugline (phone 0844 412 4665) at The Breastfeeding Network, Paisley, Scotland. Call the Drugline for information on taking prescription drugs while breastfeeding, or visit their website for handouts on drugs and breastfeeding.

Herbs

Like traditional medications, herbs also have risk categories:

source: The Nursing Mother’s Herbal by Sheila Humphrey, BSc, RN, IBCLC

A
No contraindications, side effects, drug interactions, or pregnancy-related safety issues have been identified. Generally considered safe when used appropriately.
B
May notbe appropriate for self-use by some individuals or dyads, or may cause adverse effects if misused. Seek reliable safety and dose information.
C
Moderate potential for toxicity, mainly dose related. Seek an expert herbalist as well as a lactation consultant before using. Consider safer herbs.
D
Use only with the supervision of a knowledgeable physician. Consult with a lactation specialist before use. These herbs are used to make prescription medications. The pharmaceutical forms may be safer in most instances, but not always. Do not use these herbs without the guidance of a supervising physician. Consider using safer herbs.
E
Avoid. Toxic plant with no justifiable medical use.

It is possible for anyone (mother or baby) to have an allergic reaction to just about anything. Watch your baby closely for any adverse reactions if you take any herb or medication.

Keep in mind that most herbal treatments have not been thoroughly researched, particularly in regard to lactation. “Natural” substances are not automatically safe! Herbs are drugs, so it is necessary to use caution when using them.

Here are some suggestions for nursing moms when considering herbal remedies, from Ruth A. Lawrence, MD (author of Breastfeeding: A Guide for the Medical Profession):

  • Avoid the pharmacologically active herbal teas. Drink any herbal teas only in moderation.
  • Limit intake of any herbal preparation that combines several active ingredients.
  • Always check the label. Even vitamins and simple echinacea may contain herbs that should not be used by breastfeeding mothers.
  • Use only reliable brands that have ingredients and concentrations clearly marked on the label, as well as the expiration date and the name of the manufacturer and distributor.
  • Be sure to check with your physician before taking any natural remedy, since it could interact with other medications you take or need.

    Source:Herbs and Breastfeeding by Ruth A. Lawrence, MD

Other Herbal references:

Herbal Galactagogues from wildroots.com

National Institutes of Health: Office of Dietary Supplements

The information presented here is not intended to diagnose health problems or to take the place of professional medical care. If you have persistent medical problems, or if you have further questions, please consult your doctor or member of your health care team.