Many medications can be used safely by women who are breastfeeding and the benefits of breastfeeding outweigh most harms related to babies’ exposure, a panel of pediatricians said today.

In a clinical report, the American Academy of Pediatrics (AAP) Committee on Drugs said mothers may be “inappropriately advised” to stop breastfeeding or to stop taking their medications, for fear the drugs will be passed through breast milk and harm infants.

“Sometimes people are told that, because physicians may be worried about the risks the drug may pose ... and aren’t necessarily thinking about the potential benefit of breastfeeding,” Dr. Hari Cheryl Sachs, the lead author on the report, said.

That benefit includes a lower risk of ear infections, asthma and sudden infant death syndrome, according to the U.S. Department of Health and Human Services.

Sachs said properties of the drug itself, whether it’s being used on a long- or short-term basis and the age and health of the infant all affect how safe it is to use medication while breastfeeding.

“It’s hard to make a blanket recommendation on what drugs are fine for the mother, because it’s going to depend on multiple factors,” Sachs, from the Pediatric and Maternal Health Team in the Food and Drug Administration’s Center for Drug Evaluation and Research, told Reuters Health.

“It’s always a risk-benefit decision.”

She and her colleagues on the AAP committee said women seeking information on specific medicines should talk with their doctors and visit the National Institutes of Health-run website, LactMed.

That site includes the most up-to-date scientific knowledge on how much of a given drug is passed to an infant during breastfeeding, its effects on babies and possible alternatives to consider.

In its report, published Monday in Pediatrics, the committee focused on a few classes of drugs, including antidepressants, narcotics and smoking cessation aids.

Limited information is available on the long-term effects of antidepressants on babies, it wrote, and because the drugs take a long time to break down, levels could build up in infants’ bodies.

“Caution is advised” for certain powerful painkillers such as codeine and hydrocodone - but others including morphine are considered safer when used at the lowest possible dose and for the shortest possible time, pediatricians said.

Nicotine replacement therapy, especially gum and lozenges, is typically considered safe to use during breastfeeding, according to the committee. However the FDA discourages the use of stop-smoking drugs such as varenicline, marketed in the U.S. as Chantix, among women who breastfeed.

The risk of exposure to any drug for babies needs to be weighed against the drug’s importance for the mother as well as the benefits of breastfeeding, researchers noted.

“The starting point of the report, stressing that the vast majority of drugs are compatible with breastfeeding, is very important in trying to reverse the high level of anxiety and misperception of breastfeeding mothers and many health professionals,” Dr. Gideon Koren, director of the Motherisk Program at The Hospital for Sick Children in Toronto, told Reuters Health in an email.

Koren, who wasn’t involved in the AAP publication, also pointed people to the LactMed database but said he believes the new clinical report “will be widely used and cited.”

Women who are breastfeeding should tell their doctors about any over-the-counter drugs and herbal remedies they may be using, Sachs said, in addition to prescription medications.

SOURCE: Pediatrics, online August 26, 2013

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