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Yearly Archives: 2018

Bisoprolol and Breastfeeding

Bisoprolol use seems to be increasing from the queries I receive. It is difficult to assess safety as published information relies on one study where the level in milk was undetectable BUT the baby was not given any of its mother’s milk. If other beta blockers are not suitable then the baby should be monitored closely for side effects and particularly hypo-glycaemia if newborn.

The manufacturer states that small amounts (<2%) are secreted into milk of animals. If used during breastfeeding monitor the baby for drowsiness, lethargy, weight gain and effective feeding

Bispropolol and breastfeeding factsheet

Wendy Jones MBE

That new title is going to take a lot of getting used to! I am very proud and delighted to have been nominated for an MBE for services to mothers and babies as a founder of the Breastfeeding Network Drugs in Breastmilk Service. I never thought this would happen to me following a path which I didnt really plan 22 years ago but has led me to this amazing place. I feel inspired to keep going and hopefully change some more professional attitudes that prescribing a medication doesnt mean that a mother needs to interrupt breastfeeding. Thank you to the many, many people who have sent messages of congratulations today – I appreciate them so much.

I also want to thank my wonderful family for their support – my husband Mike, my daughters Kerensa, Bethany and Tara, my son in laws Christian, Steve, Rich and Ian and of course my treasured grandchildren Stirling, Isaac, Beatrix and Elodie and the new bump due in 2019. I cant tell you how much I love you all

https://www.portsmouth.co.uk/news/new-year-s-honours-waterlooville-woman-says-passion-to-help-new-mothers-led-to-award-1-8752274

Change to recommendation on the use of Teething gels containing lidocaine.

We all know as parents how hard it is to comfort a baby who is teething and to witness their distress. As a pharmacist, mother and grandmother I know that the standard products often recommended in the past contained a local anaesthetic often lidocaine.

In 2014 the FDA in USA first raised concerns stating that “Topical pain relievers and medications that are rubbed on the gums are not necessary or even useful because they wash out of the baby’s mouth within minutes, and they can be harmful”.

Today the MHRA have announced that parents and caregivers are being advised that products containing lidocaine used for teething in babies and children will be sold only in pharmacies, under the supervision of a pharmacist from the beginning of 2019. The MHRA review concluded there is a lack of evidence of benefit to using products containing lidocaine for teething before non-medicinal options. Evidence of any risk associated with these products is very small given the wide usage of these medicines. A pharmacist or healthcare professional can provide appropriate guidance. Teething is a natural process and lidocaine containing teething products such as teething gels should only be used as a second line of treatment after discussion with and guidance of a healthcare professional.

It is suggested that parents try non-medicine options such as rubbing or massaging the gums or a teething ring before considering teething gels after discussion with a pharmacist.

Further information can be found :
www.gov.uk/government/news/teething-gels-for-babies-and-children-to-be-sold-in-pharmacies-only

And a patient information leaflet: https://assets.publishing.service.gov.uk/media/5c0fd7cbed915d0c736a1e64/Lidocaine-patient-sheet.pdf

La Leche League GB have produced an excellent article on teething which can be accessed www.laleche.org.uk/breastfeeding-and-teething/#Pain.

The NHS also has sound information:

https://www.nhs.uk/conditions/pregnancy-and-baby/teething-tips/

Products include Dentinox gel ®, Calgel ®, Bonjela ®, Anbesol gel ®

Orlistat for Weight Loss and Breastfeeding

orlistat and breastfeeding

Neuropathic pain – gabapentin, amitriptyline and pregabalin and Breastfeeding

On my mission again today to write information on the frequently asked questions by mothers and professionals. Neuropathic pain affects many mothers with chronic conditions and the data is not easy to find. I hope this information, much taken from my book, is useful.

If these fact sheets are proving helpful in your practice maybe you need a copy of Breastfeeding and Medication – available from Amazon and Routledge

Neuropathic pain and breastfeeding

Terminations of pregnancy and Breastfeeding

I have had 6 mothers contact me in the past 72 hours asking about continuing to breastfeed an older child after a termination. It is hard enough to have to make the decision to terminate without having to lose the current breastfeeding experience. So here, without judgement, is the information that mothers, their family and professionals may need to protect that relationship.

This is data taken from my book. Why not buy a copy! Worth every penny

terminations and breastfeeding

Cocaine and Breastfeeding

Using cocaine when breastfeeding is obviously not a good idea, apart from being illegal. But from messages I get almost every week it seems not uncommon. Everyone says that they are embarrassed and regretful and promise not to do again but need to know how to maintain milk supply and keep baby safe. In my quest to provide information to frequently asked questions this is detailed research on cocaine and the breastfeeding mother taken from an article I wrote for The Practising Midwife (Jones W Cocaine use and the breastfeeding mother. Pract Midwife. 2015 Jan;18(1):19-22.) as well as my book Breastfeeding and Medication

Breastfeeding and Cocaine use

Cocaine use and the Breastfeeding Mother (PubMed)

Bismuth subsalicylate (Pepto Bismol®) and Breastfeeding

 

Another of the frequently asked questions is the use of Pepto Bismol™ for indigestion or nausea

Pepto Bismol™ is marketed to relieve symptoms of upset stomach and diarrhoea. It’s active ingredient is bismuth subsalicylate, so it is related to aspirin which we avoid during breastfeeding at painkilling doses.

We are unsure if bismuth subsalicylate passes into a mother’s breast milk. Although bismuth salts are poorly absorbed from the maternal GI tract, significant levels of salicylate could be absorbed in theory. There are currently no reports of Reye’s syndrome in babies exposed to bismuth subsalicylate and it is normally only used very short term for stomach upset.

Breastfeeding mothers would be well advised to use alternative products to treat acute diarrhoea E.g. loperamine (Imodium®) if possible. However, In my experience of queries Pepto Bismol may be the only product available late at night and at weekends. The risk of short term use is probably low although this cannot be proved. The decision remains with the mother as to whether she wants to take it. Continuing to breastfeed during a stomach upset transfers antibodies to the baby to offer protection from the bacterial or viral condition.

It is also advertised to treat heartburn and indigestion for which there are many alternative remedies which are safe in breastfeeding, containing aluminium, calcium and magnesium carbonate.

 

Treating coughs. colds and sore throat in the breastfeeding mum facebook live video

Every year there are many questions on coughs, colds and sore throat so thought I would pre-empt them this year by recording a live video as well as the links and fact sheets

Hope everyone has a healthy winter !

Treating coughs colds and sore throats in the breastfeeding mother

cough and cold remedies and breastfeeding 2018

sore throat and breastfeeding 2018

Treating coughs, colds and sore throats in the breastfeeding mother

Lots of coughs and colds starting already so some information to pre-empt the questions which come every year

Posted by Breastfeeding and Medication on Thursday, September 13, 2018
Breastfeeding and Chronic Medical Conditions, Wendy Jones

Post partum cardiomyopathy and breastfeeding

Great article from UKDILAS – www.cfrjournal.com/articles/postpartum-cardiomyopathy-and-considerations-breastfeeding

Abstract

Postpartum cardiomyopathy (PPCM) is a rare condition that develops near the end of pregnancy or in the months after giving birth, manifesting as heart failure secondary to left ventricular systolic dysfunction. Clinical progression varies considerably, with both end-stage heart failure occurring within days and spontaneous recovery seen. Treatment pathways for heart failure are well established, but the evidence about the safety of medicines passed to infants during breastfeeding is scarce and mainly poor; this often leads to an incorrect decision that a mother should not breastfeed. Given its benefits to both mother and infant, breastfeeding should not routinely be ruled out if the mother is taking heart failure medication but the consequences for the infant need to be considered. An informed risk assessment to minimise potential harm to the infant can be carried out using the evidence that is available along with a consideration of drug properties, adverse effects, paediatric use and pharmacokinetics. In most cases, risks can be managed and infants can be monitored for potential problems. Breastfeeding can be encouraged in women with cardiac dysfunction with PPCM although treatment for the mother takes priority with breastfeeding compatibility being the secondary consideration. International research is continuing to establish efficacy and safety of pharmacotherapy in PPCM.

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