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Worcestershire Health and Care NHS Trust

Prescribing for Breastfeeding

NICE guidance on maternal and child nutrition (NICE 2008) states that health professionals should discuss the benefits and risks associated with prescribed medication with the breastfeeding Mother, and encourage her to continue breastfeeding, if it is reasonable to do so.

The health benefits of breastfeeding for both Mothers and babies are well documented (Horta 2007, Ip 2007). The Department of Health recommends exclusive breastfeeding up to 6 months and continued breastfeeding for at least one year.

Prescribing for breastfeeding Mothers can be a challenge because it can be difficult to find information about transmission of a particular drug in breast milk. Many drugs are unlicensed for use during lactation, not because they are known to be unsafe, but because research has not been carried out to confirm safety. Data may be available on the amount of a drug which passes to the baby via breast milk. General guidelines for prescribing are that:

  • Most drugs pass into breast milk, but generally in very small amounts (less than 1%)
  • It is safe to continue breastfeeding when taking most medications. If insufficient information on any one drug is available, it may be possible to use an alternative about which more is known
  • The age of the baby is important when making a prescribing decision, as with increasing maturity the baby is more able to detoxify any drug in breast milk
  • If a drug is available in a formulation for children it is likely to be safe to be taken by breastfeeding women.

Appendix 5 of the British National Formulary does not give full evidence-based data on which to base individual decisions. It is therefore important that health professionals who prescribe or dispense drugs to a breastfeeding Mother consult supplementary sources. Such sources include:

  • The  UKMiCentral website for the UKMi drugs in lactation service
  • TOXNET Toxicology Data Network website.
    An American website which allows searching for particular medications.
    NB Some drugs may not be known by the same name as in England, e.g.
    paracetamol and acetaminophen
  • Breastfeeding Network website.
    This information has been collated by Wendy Jones, Primary Care Pharmacist.
    The website offers the following PDF factsheets:
    • Introduction to the safety of drugs passing through breast milk
    • Analgesics and breastfeeding
    • Antibiotics and breastfeeding
    • Constipation treatment in breastfeeding Mothers
    • Cough and cold remedies and breastfeeding
    • Day surgery and breastfeeding Mothers
    • Dental treatment and breastfeeding
    • Emergency hormonal contraception and breastfeeding
    • Flu injections and breastfeeding
    • Galactagogues and breastfeeding
    • Haemorrhoids treatment in breastfeeding Mothers
    • Hay fever and allergy treatment and breastfeeding
    • Head lice treatment in breastfeeding Mothers
    • Nicotine replacement therapy (NRT) and breastfeeding
    • Postnatal depression and antidepressant use in breastfeeding
    • Threadworm treatment in breastfeeding Mothers
    • Thyroid medication and breastfeeding