Medication use during breastfeeding

Abstract

Breastfeeding period is not only a concern of healthy women. Pharmacotherapy for the treatment of mother’s newly diagnosed and/or current diseases may be required. Ensuring the continuation of breastfeeding, which has tremendous benefits for both mother and baby, is critical. Witholding the appropriate treatment due to the concerns regarding possible adverse effects of medications on the infant may lead to other detrimental consequences for both. If medication use cannot be avoided, an evidence-based assessment should be done in order to evaluate whether the mother can breastfeed during pharmacotherapy. The available evidence should be interpreted in a rational and clear manner. Because the majority of the medications are transferred into breast milk, the principal question should not be whether the medication is transferred into breast milk but whether the present amount in the milk would cause severe or serious side effects. The choice of a medication for the breastfeeding mother is a process which is influenced by several factors and should be conducted in an individualized manner. In general, medications with a relative infant dose less than 10%, higher protein-binding, lower oral bioavailability and liposolubility, and shorter half-lives should be preferred. Another important selection criteria is the presence of safety data in observational studies conducted during the breastfeeding period. In this review we aimed to examine the general approach to medication use during breastfeeding by particularly focusing on how to conduct the evidence-based risk-assessment in clinical practice, in order to increase the knowledge and awareness of clinicians’ in this regard.