Literature review for - Flourish Paediatrics

Pharmaceutical and other drugs and breastfeeding
Narrative review
The Therapeutic Goods Administration(TGA) publishes information on the risk of drug use
in pregnancy (Australian Drug Evaluation Committee 1999). There have been four updates,
available on line.
No similar book is available on pharmaceuticals in lactation in Australia but the TGA website
includes the following document:
“Guideline on Risk Assessment of Medicinal Products on Human Reproduction and
Lactation: From Data To Labelling” a document prepared by the European Medicines
Agency (European Medicines Agency 2008)
Given the constantly changing data available, a list of active websites may be more useful
than a list of drugs in the guidelines. Many manufacturers simply state that their drugs have
not been tested in pregnancy and lactation and are therefore not recommended for use in
lactating women. This increases the risk that mothers will stop breastfeeding when it would
be safe for them to continue.
Several government institutions are making available information online that can be readily
accessed:
Lactmed provided by the US National Library of Medicine is a database of drugs and other
chemicals to which breastfeeding mothers may be exposed (http://toxnet.nlm.nih.gov/). It
includes information on the levels of such substances in breastmilk and infant blood, and the
possible adverse effects in the nursing infant. Statements of the American Academy of
Pediatrics concerning a drug’s compatibility with breastfeeding are provided, as are
suggested therapeutic alternatives to those drugs, where appropriate. All data are derived
from the scientific literature and fully referenced. Data are organized into substance-specific
records, which provide a summary of the pertinent reported information and include links to
other NLM databases. Supplemental links to breastfeeding resources from credible
organizations are also provided.
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