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.
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.