Many Drugs Found Safe in Breast Feeding

reposted from the WSJ 8/30

Breast-feeding mothers can take most prescription drugs without risking their babies’ health, though they should try to avoid certain painkillers, psychiatric drugs and herbal treatments, the American Academy of Pediatrics said in a report.

In its first statement on the question in 12 years, the influential pediatricians group said many women are needlessly advised to either stop breast-feeding or forgo medicines, potentially depriving both mother and infant of important health benefits. Similarly, most vaccines are safe for nursing mothers and for their babies, the statement said.

The report, published online Monday in the journal Pediatrics, “is really an affirmation of current thinking,” said primary author Hari Cheryl Sachs, a pediatric and maternal health expert at the Food and Drug Administration. But it reflects more comprehensive information than was available when the AAP last issued a position on the issue in 2001, advising at the time that in many cases stopping breast-feeding may not be warranted.

“Before assuming that you need to stop breast-feeding, there may be information that lets you know whether that really is advisable,” Dr. Sachs said.

Most drugs don’t get into breast milk in clinically meaningful levels, the new report indicated. But use of several narcotics, including codeine, hydrocodone and oxycodone, is discouraged. Some antidepressants, antipsychotics and drugs to treat substance abuse are considered worrisome; others are acceptable.

“This is a long-awaited statement,” said Ruth Lawrence, a breast-feeding expert at the University of Rochester Medical Center in Rochester, N.Y., who wasn’t involved in the report. “The tendency among practitioners is to say, ‘I don’t know the answer, therefore why don’t you stop breast-feeding,’ ” she said. “There are very few drugs that are contraindicated while breast-feeding.”

For instance, the antidepressants sold under the brand names Prozac and Wellbutrin show up in breast milk in higher concentrations than Paxil, which would be preferred for nursing mothers, Dr. Lawrence said.

The new report took a dim view of herbal supplements for nursing mothers, partly because of a lack of data on safety and effectiveness. It specifically warned against use of the aphrodisiac yohimbe, which has been associated with reports of deaths in children, and cautioned that St. John’s wort, sometimes used for depression or anxiety, “may cause colic, drowsiness or lethargy in the breastfed infant.”

Generally, Dr. Sachs said, nursing mothers should inform pediatricians of any drugs or herbal products they are taking and discuss whether alternatives might be better for their babies.

The report, which comes as the FDA is taking steps to include more information about pregnancy and breast-feeding in drug labels, notes that it represents the views of the AAP, not the regulatory agency.

The report also said the most up-to-date and comprehensive information related to drugs and breast-feeding is compiled in a National Institutes of Health database called LactMed,available on the Internet and as an app for mobile devices.

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