Megadodo
10-19-2007, 04:26 PM
Link below includes a list of drugs approved by the AAP as usually compatible with breastfeeding.
See "Table 6" although other portions of the document may also be of interest.
AAP (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776?fulltext=ciprofloxacin&searchid=QID_NOT_SET)
Also, if you have a question, post it in the debate forum (for a quick response) and ask if someone with a Hale's Medications and Mothers' Milk reference can look it up for you. (I have one)
*****************
Another link with a good summary table:
from Baby Center (http://www.babycenter.com/general/baby/babybreastfeed/8790.html)
********************
LACTATION CATEGORIES
From: http://www.drjaygordon.com/bf/lactationrisk.htm
A brief skim of this information seems identical to the 2004 of Hale's book, too.
quote:Lactation Risk Categories
by Cheryl Taylor White, CBE
There are times when a nursing mom needs to take certain medications. Many physicians are simply not well educated on medications and the safety of taking them while breastfeeding. They may give information that is inaccurate and/or recommend that a mom wean to take a medication. Breastfeeding is so very vital to an infant’s health and development and should be guarded more vigilantly by our medical community. There truly is a small number of medications that are contraindicated for breastfeeding.
Dr. Thomas Hale is the leading expert on breastfeeding and medications. If you have been prescribed a medication and been instructed to wean to take it, take the time to get the accurate information on that medication and how it pertains to nursing. Your proactive manner of handling this could be what saves your breastfeeding relationship!
L1
SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
L2
SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
L3
MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4
POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
L5
CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.
There are other categories listed in the "How to Use this Book" section of Dr. Hale's book. They include:
Theoretic Infant Dose:
This is an estimate of the maximum likely dose per kilogram per day that an infant would ingest via milk. Because the literature is highly variable, I used several methods to calculate this estimate. First, if the authors provided milk AUC information, I used this data to estimate the dose to the infant as it is much more accurate. But more commonly, the only data provided was the peak milk level, also called Cmax. In these cases I used this data to derive the theoretic infant dose. For determining dose I used the standard milk intake of 150 mL/kg/day multiplied times the concentration of medication in milk (Cmax/Liter X 0.150 mL/kg/day = TID). Please remember, this is generally the maximum concentration that would be transferred. Most often the actual dose to the infant would be much lower. If you know the maternal dose, calculate the Relative Infant Dose using the formula on page 12. It may prove very useful.
Adult Concerns:
This section lists the most prevalent undesired or bothersome side effects listed for adults. As with most medications, the occurrence of these if often quite rare, generally less than 1 - 10% of the time. Side effects vary from one patient to another and should not be overemphasized, since most patients do not experience untoward effects.
Pediatric Concerns:
This section lists the side effects noted in the published literature as associated with medications transferred via human milk. Pediatric concerns are those effects that were noted by investigators as being associated with drug transfer via milk. They are not the effects that would result from direct administration to the infant. In some sections, I have added comments that may not have been reported in the literature, but are well known attributes of this medication and are useful information to provide the mother so that she can better care for her infant ("Observe for weakness, apnea").
From: Medications and Mothers' Milk (2002) by Thomas W. Hale, PhD
03/2004
See "Table 6" although other portions of the document may also be of interest.
AAP (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776?fulltext=ciprofloxacin&searchid=QID_NOT_SET)
Also, if you have a question, post it in the debate forum (for a quick response) and ask if someone with a Hale's Medications and Mothers' Milk reference can look it up for you. (I have one)
*****************
Another link with a good summary table:
from Baby Center (http://www.babycenter.com/general/baby/babybreastfeed/8790.html)
********************
LACTATION CATEGORIES
From: http://www.drjaygordon.com/bf/lactationrisk.htm
A brief skim of this information seems identical to the 2004 of Hale's book, too.
quote:Lactation Risk Categories
by Cheryl Taylor White, CBE
There are times when a nursing mom needs to take certain medications. Many physicians are simply not well educated on medications and the safety of taking them while breastfeeding. They may give information that is inaccurate and/or recommend that a mom wean to take a medication. Breastfeeding is so very vital to an infant’s health and development and should be guarded more vigilantly by our medical community. There truly is a small number of medications that are contraindicated for breastfeeding.
Dr. Thomas Hale is the leading expert on breastfeeding and medications. If you have been prescribed a medication and been instructed to wean to take it, take the time to get the accurate information on that medication and how it pertains to nursing. Your proactive manner of handling this could be what saves your breastfeeding relationship!
L1
SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
L2
SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
L3
MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4
POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
L5
CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.
There are other categories listed in the "How to Use this Book" section of Dr. Hale's book. They include:
Theoretic Infant Dose:
This is an estimate of the maximum likely dose per kilogram per day that an infant would ingest via milk. Because the literature is highly variable, I used several methods to calculate this estimate. First, if the authors provided milk AUC information, I used this data to estimate the dose to the infant as it is much more accurate. But more commonly, the only data provided was the peak milk level, also called Cmax. In these cases I used this data to derive the theoretic infant dose. For determining dose I used the standard milk intake of 150 mL/kg/day multiplied times the concentration of medication in milk (Cmax/Liter X 0.150 mL/kg/day = TID). Please remember, this is generally the maximum concentration that would be transferred. Most often the actual dose to the infant would be much lower. If you know the maternal dose, calculate the Relative Infant Dose using the formula on page 12. It may prove very useful.
Adult Concerns:
This section lists the most prevalent undesired or bothersome side effects listed for adults. As with most medications, the occurrence of these if often quite rare, generally less than 1 - 10% of the time. Side effects vary from one patient to another and should not be overemphasized, since most patients do not experience untoward effects.
Pediatric Concerns:
This section lists the side effects noted in the published literature as associated with medications transferred via human milk. Pediatric concerns are those effects that were noted by investigators as being associated with drug transfer via milk. They are not the effects that would result from direct administration to the infant. In some sections, I have added comments that may not have been reported in the literature, but are well known attributes of this medication and are useful information to provide the mother so that she can better care for her infant ("Observe for weakness, apnea").
From: Medications and Mothers' Milk (2002) by Thomas W. Hale, PhD
03/2004