Is that drug safe for breastfeeding?

The answer is almost always “yes,” but that’s often not what mothers hear from doctors and pharmacists.  Early in my training, I came in on a Monday morning to round on the patients who had given birth over the weekend. One mother had had a CT scan, and she had been told that she had to pump and dump her milk for 48 hours because the IV medication given during the CT was dangerous for her baby. I clearly remember calling a medication safety information line and finding out that there was minimal risk to breastfeeding immediately after a CT scan. The mother put the baby to breast right away, but had lost 2 days of early breastfeeding. For some babies, that can completely derail the breastfeeding experience.

Many clinicians assume that drugs that are safe in pregnancy are also safe in lactation — and drugs that are dangerous in pregnancy can’t be used during breastfeeding. That’s simply not the case.

Moreover, many databases and books on drug safety don’t include accurate information. In fact, in a study, the data bases used by pharmacies like CVS eroneously rated multiple drugs as dangerous that are safe in breastfeeding. So how can you get good information?

My favorite resource is LactMed, a free, online resource from the National Library of Medicine. LactMed is regularly updated, and includes a summary of the key studies on each drug, as well as alternative options in the same class. Another wonderful resource is Tom Hale’s Medications and Mothers’ Milk. The take-home message is to check a reliable source before telling a mother whether a drug is safe in breastfeeding.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine.