Many medications can be used safely by women who are
breastfeeding and the benefits of breastfeeding outweigh most harms related to
babies' exposure, a panel of paediatricians said today.
In a clinical report, the American Academy of Pediatrics
(AAP) Committee on Drugs said mothers may be "inappropriately
advised" to stop breastfeeding or to stop taking their medications, for
fear the drugs will be passed through breast milk and harm
infants."Sometimes people are told that, because physicians may be worried
about the risks the drug may pose... and aren't necessarily thinking about the
potential benefit of breastfeeding," Dr Hari Cheryl Sachs, the lead author
on the report, said.
That benefit includes a lower risk of ear infections, asthma
and sudden infant death syndrome, according to the US Department of Health and
Sachs said properties of the drug itself, whether it's being
used on a long- or short-term basis and the age and health of the infant all
affect how safe it is to use medication while breastfeeding.
"It's hard to make a blanket recommendation on what
drugs are fine for the mother, because it's going to depend on multiple
factors," Sachs, from the Pediatric and Maternal Health Team in the Food
and Drug Administration's Center for Drug Evaluation and Research, told Reuters
Health. "It's always a risk-benefit decision."
Up-to date scientific
"She and her colleagues on the AAP committee said women
seeking information on specific medicines should talk with their doctors and
visit the National Institutes of Health-run website, LactMed. (The site
includes the most up-to-date scientific knowledge on how much of a given drug
is passed to an infant during breastfeeding, its effects on babies and possible
alternatives to consider.)
In its report,
published Monday in Pediatrics, the committee focused on a few classes of
drugs, including antidepressants, narcotics and smoking cessation aids.
is available on the long-term effects of antidepressants on babies, it wrote,
and because the drugs take a long time to break down, levels could build up in
infants' bodies. "Caution is advised" for certain powerful
painkillers such as codeine and hydrocodone – but others including morphine are
considered safer when used at the lowest possible dose and for the shortest
possible time, paediatricians said.
Nicotine replacement therapy, especially gum and lozenges,
is typically considered safe to use during breastfeeding, according to the
committee. However, the FDA discourages the use of stop-smoking drugs such as
varenicline, marketed in the US as Chantix, among women who breastfeed.
Risk of exposure
The risk of exposure to any drug for babies needs to be
weighed against the drug's importance for the mother as well as the benefits of
breastfeeding, researchers noted.
"The starting point of the report, stressing that the
vast majority of drugs are compatible with breastfeeding, is very important in
trying to reverse the high level of anxiety and misperception of breastfeeding
mothers and many health professionals," Dr Gideon Koren, director of the
Motherisk Program at The Hospital for Sick Children in Toronto, told Reuters
Health in an email.
Koren, who wasn't
involved in the AAP publication, also pointed people to the LactMed database
but said he believes the new clinical report will be widely used and
"Women who are breastfeeding should tell their doctors
about any over-the-counter drugs and herbal remedies they may be using, Sachs
said, in addition to prescription medications.