Medication use during breastfeeding
Breastfeeding period is not only a concern of healthy women. Pharmacotherapy for the treatment of mother’s newly diagnosed and/or current diseases may be required. Ensuring the continuation of breastfeeding, which has tremendous benefits for both mother and baby, is critical. Witholding the appropriate treatment due to the concerns regarding possible adverse effects of medications on the infant may lead to other detrimental consequences for both. If medication use cannot be avoided, an evidence-based assessment should be done in order to evaluate whether the mother can breastfeed during pharmacotherapy. The available evidence should be interpreted in a rational and clear manner. Because the majority of the medications are transferred into breast milk, the principal question should not be whether the medication is transferred into breast milk but whether the present amount in the milk would cause severe or serious side effects.
The choice of a medication for the breastfeeding mother is a process which is influenced by several factors and should be conducted in an individualized manner. In general, medications with a relative infant dose less than 10%, higher protein-binding, lower oral bioavailability and liposolubility, and shorter half-lives should be preferred. Another important selection criteria is the presence of safety data in observational studies conducted during the breastfeeding period. In this review we aimed to examine the general approach to medication use during breastfeeding by particularly focusing on how to conduct the evidence-based risk-assessment in clinical practice, in order to increase the knowledge and awareness of clinicians’ in this regard.
- Victora CG, Bahl R, Barros AJ et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387(10017): 475-90.
- Kersten I, Lange AE, Haas JP et al. Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study. BMC Pregnancy Childbirth 2014; 14: 75.
- Dunlop AL, Jack BW, Bottalico JN et al. The clinical content of preconception care: women with chronic medical conditions. Am J Obstet Gynecol 2008; 199(6 Suppl 2): 310-27.
- Pearlstein T. Depression during pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29(5): 754-64.
- Werder E, Mendola P, Männistö T, O’Loughlin J et al. Effect of maternal chronic disease on obstetric complications in twin pregnancies in a U.S. cohort. Fertil Steril 2014; 100(1): 142–9.
- Türkiye İstatistik Kurumu. Temel istatistikler, nüfus ve demografi, hayati göstergeler. http://www.turkstat.gov.tr/ PreIstatistikTablo.do?istab_id=1592 adresinden 14/02/2019 tarihinde erişilmiştir.
- Sriraman NK, Melvin K, Meltzer-Brody S. ABM clinical protocol #18: use of antidepressants in breastfeeding mothers. Breastfeed Med 2015; 10(6): 290-9.
- Ilett KF, Kristensen JH. Drug use and breastfeeding. Expert Opin Drug Saf 2005; 4(4): 745-68.
- Orme ML, Lewis PJ, De Swiet M et al. May mothers given warfarin breast-feed their infants? Br Med J 1977; 1: 1564-5.
- McKenna R, Cole ER, Vasan U. Is warfarin sodium contraindicated in the lactating mother? J Pediatr 1983; 103: 325-7.
- Begg EJ, Duffull SB, Hacket LP et al. Studying drugs in human milk: time to unify the approach. J Hum Lact 2002; 18(4): 323-32.
- Kelsey JJ. Women’s and Men’s Health. PSAP 2016 Book 3. ACCP, 2016; 7-31.
- Hale TW, Rowe HE. Medications and Mothers Milk. On yedinci baskı. New York, NY: Springer Publishing Company, 2017.
- Hotham N, Hotham E. Drugs in breastfeeding. Aust Prescr 2015; 38(5): 156-9.
- Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment. Üçüncü baskı. Oxford, Elsevier-Academic Press, 2015.
- Berle JO, Spigset O. Antidepressant use during breastfeeding. Curr Womens Health Rev 2011; 7(1): 28-34.
- Kaplan YC, Koren G, Ito S et al. Fluconazole use during breastfeeding. Can Fam Physician 2015; 61(10): 875–6.
- Hale TW. Medications and Mothers’ Milk. Sekizinci baskı. Amarillo, Tex.: Pharmasoft Medical, 1999.
- Da Silva OP, Knoppert DC. Domperidone for lactating women. CMAJ 2004; 171: 725-6.
- Madadi P, Koren G, Cairns J, et al. Safety of codeine during breastfeeding: fatal morphine poisoning in the breastfed neonate of a mother prescribed codeine. Can Fam Physician 2007; 53(1): 33-5.
- Stultz EE, Stokes JL, Shaffer ML, Paul IM, Berlin CM. Extent of medication use in breastfeeding women. Breastfeed Med 2007; 2(3): 145-51.
- Spencer JP, Gonzalez LS 3rd, Barnhart DJ. Medications in the breast-feeding mother. Am Fam Physician 2001; 64(1): 119-26.23. Drugs and Lactation Database (LactMed). http://toxnet.nlm.nih.gov/newtoxnet/lactmed adresinden 14/05/2019 tarihinde erişilmiştir.
- Reprotox.org. (2019). https:// reprotox.org/ adresinden 14/05/2019 tarihinde erişilmiştir.