When counseling breastfeeding mothers who intend to take or are taking medications (prescription, over-the-counter, and/or herbal), the questions below should be considered and asked. The provided answers are necessary to properly counsel mothers on the safe and effective use of medications while breastfeeding. A stepwise approach based upon these answers can then be used to minimize infant drug exposure while breastfeeding. The steps evolve from not taking a medication to discontinuing breastfeeding. Steps can be skipped or combined as appropriate. Following this approach almost always allows the nursing infant to continue to breastfeed safely.
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What is the name, strength, and dosage form of the drug? SHOW |
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Do you still have the prescription? Or, have you already filled it and are taking the drug? SHOW |
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Why is the drug being prescribed? SHOW |
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Do you feel you need to take the drug? SHOW |
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What does your doctor say regarding breastfeeding outcome and taking the drug? SHOW |
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What is the drug dosage schedule and how often do you nurse? SHOW |
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How old is the baby? SHOW |
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Was your baby full-term or premature? SHOW |
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What is your baby’s weight? SHOW |
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Is your baby currently receiving any medication? SHOW |
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Do you know how to hand-express milk or do you have access to a breast pump? SHOW |
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Is this your first breastfed baby? SHOW |
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Stepwise Approach to Minimizing Infant Drug Exposure SHOW |
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1. Withhold the Drug
Avoid the use of non-essential medications by enlisting the mother’s cooperation.
2. Try Non-Drug Therapies
Suggested therapies include: Analgesics: relaxation techniques, massage, warm baths.
Cough, cold, allergy products:
saline nose drops, cool mist, steam.
Anti-asthmatics: avoid known allergens, particularly animals.
Antacids: eat small meals, sleep with head propped, avoid head-bending activities, avoid gas-forming foods.
Laxatives: eat high fiber cereal, prunes, or hot liquids with breakfast.
Anti-diarrheals: discontinue solids 12-24 hours, increase fluids, eat toast / saltine crackers.
3. Delay Therapy
Mothers who are ready to wean the infant might be able to delay elective drug therapy or elective surgery.
4. Choose Drugs That Pass Poorly Into Milk
Within some drug classes there are large differences among class members in drug distribution into milk.
5. Choose More Breastfeeding Compatible Dosage Forms
Take lowest recommended dose, avoid extra-strength and long acting preparations, avoid combination ingredient products.
6. Choose an Alternative Route of Administration
Local application of drugs to the affected maternal site may minimize drug concentrations in milk and
subsequently the infant’s dose.
7. Avoid Nursing at Times of Peak Drug Concentrations in Milk
Nursing before a dose is given may avoid the peak drug concentrations in milk that occur about 1-3 hours after an oral dose.
This works best for drugs with short half-lives.
8. Administer the Drug Before the Infant’s Longest Sleep Period
This will minimize the infant’s dose and is useful for long-acting drugs that can be given once daily.
9. Temporarily Withhold Breastfeeding
Depending on the estimated length of drug therapy, nursing can be temporarily withheld.
Mothers may be able to pump a sufficient quantity of milk beforehand for use during therapy.
The pharmacokinetics of the drug must be examined to determine when the resumption of breastfeeding is advisable.
10. Discontinue Nursing
A few drugs are too toxic to allow nursing and may be necessary for the mother’s health.
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