Breastfeeding and medicines
In accordance with NICE CG37, UNICEF’s baby friendly initiative and WHO guidelines mothers and parents should be supported to breastfeed their child. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age and beyond. Breastmilk is acknowledged as being the optimal way to feed all babies including in developed countries.
LactMed is one of the most comprehensive resources available.
Referenced in NICE PH11:
“Ensure health professionals and pharmacists who prescribe or dispense drugs to a breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation Database [LactMed] or seek guidance from the UK Drugs in Lactation Advisory Service.)
Health professionals should discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most cases, it should be possible to identify a suitable medication which is safe to take during breastfeeding by analysing pharmokinetic and study data. Appendix 5* of the ‘British national formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions.
Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse.’“
* Appendix 5 of the BNF has now been incorporated into the individual monographs of each drug.
In addition, NICE [NG194] Postnatal Care reinforces the message that women have the right to breastfeed in any public space under the protection of the Equality Act 2010, and section 1.5.6 highlights that:
Healthcare professionals caring for women and babies in the postnatal period should know about:
- breast milk production
- signs of good attachment at the breast
- effective milk transfer
- how to encourage and support women with common breastfeeding problems
- appropriate resources for safe medicine use and prescribing for breastfeeding women.
Information resources for safe prescribing
- Specialist Pharmacy Service (SPS): Advising on medicines regimens during breastfeeding (UKDILAS- UK Drugs In Lactation Service). The specialist UKDILAS service from SPS provides evidence-based information and advice to healthcare professionals on the safe use of medications in lactation, details for enquiries can be found on the Breastfeeding enquires page.
- Drugs and Lactation Database (Lactmed) The Drugs and Lactation Database contains information on drugs which may be used in lactation, a US resource cited by NICE PH11 for use as a suitable supplementary resource for prescribers.
- The Breastfeeding Network Drugs Factsheets provided by the Breastfeeding Network Drugs in Breastmilk service, providing evidence-based information covering the most common issues affecting parents.
GP and Healthcare Education
The Somerset Medicines Management Team are pleased to share an Introduction to Breastfeeding and Safety of Prescribing in Lactation training. We will be recording a webinar to compliment this material with the Infant Feeding Leads from Yeovil District Hospital and Somerset Foundation Trust.
- Breastfeeding and Medication learning resources – written by Dr Wendy Jones MBE, this resource includes the Pharmacokinetics and transport of drugs into breastmilk presentation as well as some other very valuable presentations that may be relevant to your practice.
- GPIFN is a resource put together by GPs. This has many very useful links and CPD opportunities suitable for all health care professionals.
- eLearning for Healthcare- Infant feeding resource.
- ABM link to breastfeeding training for professionals.
- How to advise women on the safe use of medicines while breastfeeding article in the Pharmaceutical Journal published in June 2021 written by Dr Wendy Jones MBE to share information for healthcare professionals.
- Guidance sheets for providing remote care during the Covid-19 outbreak
- Click the picture below for the Unicef e-learning for GPs page.
Using oral anticoagulants in breastfeeding from Specialist Pharmacy Service
It is important to seek support from suitably qualified individuals when managing breastfeeding problems.
CKS Breastfeeding Problems outlines guidance on scenarios and how to manage them and links to local and national support; includes engorgement, blocked ducts, galactocele, ductal infection, mastitis or breast abscess, nipple damage, skin conditions, nipple vasospasm or Raynaud’s disease of the nipple, low milk supply and milk oversupply.
How to advise women on the safe use of medicines while breastfeeding Dr Wendy Jones MBE links to the Pharmaceutical Journal article published in July 2021
The Breastfeeding Companion: Common Hurdles A useful NHSE approved resource which discusses various breastfeeding hurdles including nursing strike, breast abscess, breast engorgement, tongue tie, overactive letdown, increasing supply, breastfeeding and jaundice, baby not latching, comfort nursing, sore nipples, nipple blanching, breastfeeding while sick, milk blister, breastfeeding at night, mastitis, blocked milk ducts, white spots on the nipple and more.
Breastfeeding Network Drug Factsheets
CKS Breastfeeding Problems refers to the Breastfeeding Network Drug Factsheets which contain evidence based information on the most common issues with medicines and lactation. A popular resource endorsed by many breastfeeding support groups. Parents may attend a consultation with a print out or link to this. The National Breastfeeding Helpline offers breastfeeding support on the phone, every day of the year, 9.30am to 9.30pm: 0300 100 0212.
Raised cholesterol and breastfeeding from the Breastfeeding Network Drug Factsheets
Dairy Free or Vegan Diets
First Steps Nutrition have resources on eating well for new mums including information for breastfeeding mothers which has further detailed information on breastfeeding with special diets, including sources of calcium for a dairy free diet while breastfeeding.
See Vitamin D for more information on vitamin D supplementation needs for children and breastfeeding parents.
Dry Skin and Eczema
Dry skin conditions of the breast shouldn’t be mistaken for fungal or thrush infections.
Diagnosis | Diagnosis | Fungal skin infection – body and groin | CKS | NICE discusses diagnosis of fungal skin infections. Fungal treatment for fungal skin infections can be found in the Infection Management guidance.
Dry skin can cause itching, redness, and it may crack. It can affect all areas of the body but most frequently the hands, inside the elbows and behind the knees. The breastfeeding Network discusses dry skin in their factsheet: Eczema and Breastfeeding – The Breastfeeding Network.
Dry or damaged skin should be protected with frequent emollient use, the emollient guidance can be accessed on the dermatology page. Nipples can be protected with a little expressed breastmilk, or cream/ ointment such as petroleum jelly, when applied sparingly after a feed, there should be no residue, so the skin doesn’t become soggy and there is no need to wash off any remaining cream.
Mild dry skin may be treated as self-care, diagnosed skin conditions such as eczema needing emollients should follow the emollients guidance on the Dermatology page.
Lactation if you’re trans or non-binary
Trans or non-binary people can be supported to feed their babies human milk if that is their goal.
The NHS website has some useful information discussing chestfeeding, top surgery and binding while lactating.
Some more information is available in the Somerset Medicines Management Information on Breastfeeding and Safe Prescribing document found above in GP Education.
Menopause and breastfeeding
See our menopause webpage for further resources around menopause and hormone replacement therapy.
Breastfeeding and HRT – Oestrogen:
Breastfeeding and HRT – Progesterone:
Mirena® 20 micrograms/24 hours intrauterine delivery system can be used as protection from endometrial hyperplasia during oestrogen replacement therapy. See SPC for detail on length of treatment. Mirena is effective for 5 years in the indication of contraception, but 4 years for the progesterone component of HRT.
Breastfeeding and Medication – The Menopause and Breastfeeding
Please see the Mental Health Page for more information on mental health in the perinatal period
Non-opioid pain relief should be used where appropriate, where opioid pain relief is necessary specialist resources should be used including the Specialist Pharmacy Service links below:
Which weak opioids can be used during breastfeeding? Considering the evidence for codeine, dihydrocodeine, and tramadol – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice
Codeine is contraindicated while lactating. Codeine: very rare risk of side-effects in breastfed babies – GOV.UK (www.gov.uk)
Breastfeeding and medicines – NHS (www.nhs.uk) The NHS website provides some basic information for the public including paracetamol and ibuprofen.
Thrush and breastfeeding
Dry skin conditions of the breast shouldn’t be mistaken for fungal or thrush infections. Diagnosis | Diagnosis | Fungal skin infection – body and groin | CKS | NICE discusses diagnosis of fungal skin infections. Fungal treatment for fungal skin infections can be found in the Infection Management – Somerset CCG guidance.
Dry skin can cause itching, redness, and it may crack. It can affect all areas of the body but most frequently the hands, inside the elbows and behind the knees. The breastfeeding Network discusses dry skin in their factsheet: Eczema and Breastfeeding – The Breastfeeding Network. Dry or damaged skin should be protected with frequent emollient use, the emollient guidance can be accessed on the dermatology page. Nipples can be protected with a little expressed breastmilk, or cream/ ointment such as petroleum jelly, when applied sparingly after a feed, there should be no residue, so the skin doesn’t become soggy and there is no need to wash off any remaining cream.
Vitamin D should be taken for the duration of lactation. Advise breastfeeding and chestfeeding people to take Vitamin D 10 micrograms per day. PH56 Vitamin D: supplement use in specific population groups. Also suitable for self-care.
The Department of Health recommends that:
- Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms (µg) of vitamin D to make sure they get enough. This is whether or not you’re taking a supplement containing vitamin D yourself.
- Children aged 1 to 4 years old should be given a daily supplement containing 10µg of vitamin D.
- Babies being combination fed breastmilk and formula receiving over 500ml of formula per day do not require additional vitamin D supplementation.
Treatment of deficiency (Vitamin D <25nmol/l) formulary options available on the Somerset Prescribing formulary. A daily dose of 4,000iu daily for 10 weeks is preferred while lactating.
Healthy Start vitamins are available for families who qualify for free, see how to apply. Healthy Start women’s vitamin tablets contain folic acid and vitamins C and D (Children’s drops also available). FAQs. The application form must be signed by a midwife, health visitor, doctor or nurse.
The information and links provided are for guidance, clinical decisions remain the responsibility of the practitioner; the intention is to help prescribers find evidence based information and does not replace input from appropriate professionals or constitute medical advice for individual patients.