Medication transport into breastmilk Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM Lakeshore Medical Breastfeeding Medicine Clinic
•When
gap junctions close, then medications would need to penetrate 2 lipid
bilayers
to get into milk
•Similar
to blood-brain barrier
We can assume ingestion early postnatally is minimal (because there isn't a very big stomach or much colostrum volume)
For a drug to make a difference:
•Needs
to be orally available
Examples that aren't orally available: Heparin, Aminoglycosides, 3rd generation cephalosporins, radiocontrast agents
Examples that aren't orally available: Heparin, Aminoglycosides, 3rd generation cephalosporins, radiocontrast agents
•Absorbed
through GI tract
Examples that aren't:
Morphine and Sumatriptan are sequestered in the liver
•Gadolinium
salts (MRI)
•Iodinated
contrast agents (CT)
•Vancomycin
•Transferred
into milk: large molecular weight proteins like insulin
and interferon won't transfer
•Orally
available to infant: could the baby ingest it?
•Absorbed
by infant GI tract; can the baby digest it?
•Present
in a clinically significant amount: when it finally makes into the
babies bloodstream, if it does, how much gets there?
Need to consider:
•Amount
transferred to the infant
•The
age of the infant
•Effects
of the medication on the baby
•Effects
of the medication on maternal milk supply
Points to remember:
Breastfeeding
is important!
The
information is out there.
It’s
better to assume that the medication is compatible (not safe) than
ask the mother to pump and discard her milk without researching the answer.
What medication can I take while I'm breastfeeding?
General Guidelines:
- We don't throw milk away without a really, really good reason. Like you are getting chemotherapy or decided to do heroin.
- Most medications are compatible (I try to avoid saying "safe") with breastfeeding.
- Most pharmacists and other health professionals don't know #1, #2 or that good pumps can be really expensive. Sometimes they give well-intentioned bad advice. Back to #1 and #2.
- If we give it to infants, it's OK to take
- If you don't really need to take it (like cold medications) don't take it
- Most antibiotics are fine
Resources:
- and Me, although I'm just going to check LactMed
back to www.drjen4kids.com