A range of pharmaceutical care needs can arise while a mother is breastfeeding – so it is important to be familiar with the physiology of breastfeeding and breastfeeding behaviours, and be able to identify medicines that are not known to be harmful when breastfeeding.
Pharmacokinetic considerations for both mother and baby, including the changing pharmacokinetic profile of the baby as he/she gets older, alongside consideration of the potential for toxicity and acceptability (e.g. affecting taste or supply of milk) upon drug transfer into milk, are critical when advising on medication options while breastfeeding.
Breastfeeding is recommended exclusively for the first six months, continued with appropriate complementary foods thereafter. A range of pharmaceutical care needs may arise during this time, which may relate to breastfeeding (e.g. mastitis) or not.
With respect to medicines use while breastfeeding, any meaningful patient consultation should include ascertaining any prior knowledge the mother has concerning medicines use while breastfeeding, either from peers or internet-based medicines information resources.
In order to provide a breastfeeding mother with realistic supportive care, it is fundamental that the pharmacist has sufficient knowledge of breastfeeding behaviours. For example, advising a patient to express milk in advance for use during periods after medicines have been taken, and/or to discard breastmilk which the drug may have transferred into, can be difficult or impractical at short notice.
Similarly, advice in timing medications around feeds is not always feasible in practice.
Some studies have observed that breastfed babies feed a median of eight times per 24 hours in the first six months, with wide variability around this figure. Given the time for systemic absorption following oral medicines administration (and the variability around this time frame),
it is difficult to envisage how feeds can be optimally timed around frequent medicines administration to minimise infant exposure to drugs in milk. It is important to emphasise that should medication be considered necessary, there is often a treatment option available that is probably compatible with breastfeeding.
Advice on medicines use while breastfeeding is available from standard and specialist reference sources (e.g. SPCs, BNF). Additionally, queries are welcome via the specific medicines information contact at King’s College Hospital, by emailing Kch-tr.Drugsinbreastfeedingsupport@ nhs.net.
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This column is produced in association with the UKCPA. The views expressed are those of the author and are not necessarily those of either Pharmacy Magazine or the UKCPA.