Medications and Lactation: What PNPs Need to Know

Jennifer M. Marks, BS; Diane L. Spatz, PhD, RNC

J Pediatr Health Care. 2003;17(6)

Evaluation of the Infant

It is extremely important to evaluate the infant's ability to handle small amounts of medications before making a decision about the suitability of a medication for a breastfeeding woman (Hale, 2002). Evaluation of the infant includes taking into consideration the age of the infant. Premature and newborn infants are at somewhat greater risk than older infants for developing high plasma drug concentrations because of their immature hepatic and renal systems (Riordan & Auerbach, 1998). Older infants may tolerate maternally ingested medications better than the previously mentioned infants because they are larger, and the drug is distributed over a larger surface area (Riordan & Auerbach, 1998). Infant stability should also be evaluated. Infants, who are physiologically and behaviorally unstable with poor GI stability, may be at a greater risk from maternal medications.

Infant evaluation includes assessing whether or not the drug has been approved for use in the pediatric population. As mentioned previously, medications are generally less hazardous to breastfeeding infants if there is a long-term history of safety in children. As well, the dose of the medication is pertinent to the evaluation. Finally, a comprehensive infant evaluation necessitates analyzing the risks and benefits associated with drugs that are known to alter milk production capability. In relation to the breastfeeding infant, it is important to recognize that such medications may be much more risky to the mother-infant breastfeeding dyad during the high-frequency feedings that characterize the neonatal period than later in their relationship (Hale, 2002).

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Table. Drug information resources
Source	Contact Information
The Lactation Center	University of Rochester Medical Center 585-275-0088
Crozer-Chester Medical Center Drug Information Center	One Medical Center Boulevard Upland, PA 19013 610-447-2851
Brigham and Women's Hospital Boston, MA	617-732-5500; ask for clinical pharmacologist
Drugs in Lactation Web site (Hale)	www.neonatal.ttuhsc.edu/lact
Hale, T. W. (2002). Medications and Mother's Milk (10th ed.). Amarillo, TX: Pharmasoft	Ordering information: Pharmasoft Publishing Single copies $24.95, plus shipping 21 Tascocita Circle Amarillo, TX 79124-7301; tel: 800-378-1317; fax: 806-376-9901; www.iBreastfeeding.com
Drug Topics Red Book (106th ed.) (2002). Montvale, NJ: Medical Economics	Ordering information: www.medecbookstore.com
Briggs, G. G., Freeman, R. K., & Yaffe, S. J. (2002). Drugs in Pregnancy and Lactation (6th ed.)	Ordering information: Lippincott Williams & Wilkins, 530 Walnut Street Philadelphia, PA 19106

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