Breastfeeding mothers and medicines - general guidance
The following principles should be followed when prescribing for breastfeeding mothers :
- Avoid unnecessary drug use and limit use of over-the-counter (OTC) products
- Breastfeeding mothers should seek advice on the suitability of OTC products
- Assess the benefit/risk ratio for both mother and infant
- Avoid use of drugs known to cause serious toxicity in adults or children
- Drugs licensed for use in infants do not generally pose a hazard
- Neonates (and particularly premature infants) are at greater risk from exposure to drugs via breast milk, because of immature
excretory functions and the consequent risk of drug accumulation
- Choose a regimen and route of administration which presents the minimum amount of drug to the infant
- It is best to avoid long-acting preparations, especially those of drugs likely to cause serious side effects (e.g. antipsychotic agents),
as it is difficult to time feeds to avoid significant amounts of drug in breast milk
- Multiple drug regimens may pose an increased risk especially when adverse effects such as drowsiness are additive
- Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms
- Avoid new drugs if a therapeutically equivalent alternative that has been more widely used is available.
A robust assessment of the balance of benefit to risk requires data both on the drug's passage into breast milk and its effects in infants: there is rarely enough information available for new drugs to allow such an assessment to be made. If a drug with limited data is deemed to be clinically necessary or for any further information, contact the UK Drugs in Lactation Advisory Service (UKDILAS) for further advice.