Most meds safe to take while breastfeeding

Breastfeeding linked to higher intelligence in children
Breastfeeding linked to higher intelligence in children

HealthDay News -- Most medications and vaccines are safe for women to take while breastfeeding, according to updated guidelines from the American Academy of Pediatrics (AAP).

Clinicians should exercise caution for the small number of drugs that are concentrated in human milk, have a long half-life, have known toxicity or expose the infant to relatively high doses or detectable serum concentrations, Hari Cheryl Sachs, MD, a pediatrician at the FDA in Rockville, Md., and colleagues reported in Pediatrics.

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"Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants," Sachs and colleagues wrote. "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." 

They advise clinicians to look up the safety profile of specific medications in the National Library of Medicine's peer-reviewed LactMed database.

The AAP's Committee on Drugs first proposed changes to drug labeling in 2008 to make it easier to determine if it is necessary for mothers to cease lactation. Currently, the "Nursing Mothers" section simply advises caution or discontinuation of breastfeeding or the drug. The committee proposed this be replaced with a section called "Lactation," that will summarize what is known about drug secretion in breast milk, how it could potentially affect the infant, what can be done to minimize exposure and how to monitor for adverse effects.

"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 researchers wrote. 

Pain medications, psychoactive drugs, herbal products, and drugs to treat substance/alcohol abuse or smoking are of most concern during breastfeeding, they noted.

Medications including bupropion (Wellbutrin), diazepam (Valium), fluoxetine (Prozac), citalopram (Celexa), lithium (Eskalith), lamotrigine (Lamictal) and venlafaxine (Effexor) are known to accumulate at clinically significant levels in breast milk. Serotonin reuptake inhibitors, antipsychotics, anxiolytics and mood stabilizers should also be avoided due to long half-lives and relatively high infant plasma concentrations.

Whether mothers taking methadone for opioid dependence should breastfeed has been a matter of debate since the AAP committee issued it's last report in 2003. Although the product label cites risk of lethargy, respiratory difficulty and poor weight gain for exposed infants, overall methodone levels found in breast milk and infant plasma are low. The Academy of Breastfeeding Medicine currently supports breastfeeding among women in methadone-maintenance programs.

In terms of pain medication, the committee recommends caution with codeine and hydrocodone due to poor clearance in neonates and the potential for adverse events in ultra-rapid metabolizers. Other narcotic painkillers are preferred.

Regarding vaccination, maternal vaccination does not interfere with breastfeeding, and breastfeeding does not interfere with the infant response to most routine immunizations in most cases. The exceptions include HPV vaccination for mothers with infants who are vulnerable to respiratory illness, such as preterm infants, those with congenital heart disease or chronic respiratory problems, and vaccination against smallpox or yellow fever, due to the high risk of vaccinia for the child.


References

  1. Sachs HC et al. Pediatrics. 2013; 132: e796–e809; doi: 10.1542/peds.2013-1985.
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