I’m going to prescribe drug x but I’m afraid it means you need to stop breastfeeding.
Does this sound familiar. It seems to come up frequently on social media platforms but is it true?
In 2008 I was part of the guideline development group for maternal and infant nutrition PH11 https://www.nice.org.uk/Guidance/PH11. It includes a recommendation on prescribing that: sources other than solely the BNF should be consulted when prescribing for a breastfeeding mother e.g. UKDILAS (https://www.sps.nhs.uk/articles/information-resources-for-advice-on-medicines-and-breastfeeding/) or LactMed (https://www.sps.nhs.uk/articles/information-resources-for-advice-on-medicines-and-breastfeeding/). To discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. As well as to recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. Finally, to acknowledge that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse.
In 2021 the Medicines Health Regulatory Authority (MHRA) published The Safer Medicines in Pregnancy and Breastfeeding Consortium information strategy (https://www.gov.uk/government/publications/safer-medicines-in-pregnancy-and-breastfeeding-consortium) . Its aim was to set up a partnership of 16 leading organisations who are working together to improve the health information available to women thinking about becoming pregnant, are pregnant, or are breastfeeding. As part of the output of the consortium the BNF team worked with UKDILAS to present more information on breastfeeding rather than relying on the statement that manufacturers advise drug y is avoided by breastfeeding mothers. So, for example the information on antidepressant drugs now reads “Specialist sources indicate that sertraline and paroxetine are the SSRIs of choice in breast-feeding based on passage into milk, half-life, and published evidence of safety. However, all SSRIs can be used in breast-feeding with caution, and since there are risks with switching an SSRI, it may be more clinically appropriate to continue treatment with an SSRI that has been effective, or restart treatment with an SSRI that has previously been effective. With all SSRIs, infants should be monitored for drowsiness, poor feeding, adequate weight gain, gastro-intestinal disturbances, irritability, and restlessness.”
So, if a healthcare professional tells you that you can’t breastfeed on a drug or need to dump your milk for a period after a procedure maybe that may not be based on the most up to date evidence but based on older beliefs.
Prescribing nearly every drug for a breastfeeding mother needs the professional to take responsibility for the outcomes because the manufacturers are not required to do so unless they have conducted clinical trials. One of the few exceptions is Cimzia ™ (Certolizumab pegol). However, they need only show that they reached a decision that a similarly experienced practitioner might make. Using specialist sources and documenting the information shared with the breastfeeding mother would substantiate this.
I asked a Facebook group what they would say to a practitioner who said they had to stop breastfeeding in order to take a named medication. Their responses were strong and empowered whilst remaining polite. This is so different to when I first became interested in the compatibility of drugs in breastmilk in 1995. Hope this information helps you to reach your own shared decision making about what is right for you and your baby.
Suggested comments.
- Thank you for that, could you please show me the sources that you have used to come to that conclusion?
- Have you consulted specialist sources or just the BNF?
- I appreciate your opinion, but I plan to consult a specialist pharmacist before deciding to interrupt breastfeeding.
- Thank you for that information. What are the risks of the medication if I continue to breastfeed?
- Where did you get that information?
- What is the risk if I don’t take medication?
- Are you aware of the risks of stopping breastfeeding suddenly to take medication?
- If I wasn’t breastfeeding, what would you prescribe?
- Are you aware of the following resources?
- Please may I ask where you’ve checked that drug’s safety for breastfeeding?
- What are the possible risks of taking versus not taking? Is there anyone in the pharmacy team that can help? Are there any alternatives? Is there anyone you or I can consult?