I was encouraging a mother to breastfeed the other day when she asked if I was sure that was OK with her condition. Her baby is asymptomatic on a 10 day iv course of penicillin for presumed inadequately treated maternal syphilis. I wobbled momentarily and the junior doctor and I went away to look it up. It is OK apparently as long as the mother does not have syphilitic lesions around her nipples. Take a look at http://pedclerk.bsd.uchicago.edu/page/breastfeeding which is an American teaching site and has a nice summary of when you can and can’t breastfeed. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT is an American database of the evidence on the safety of various medicines when breastfeeding.
A few websites I find useful are: http://www.nelm.nhs.uk/en – good for looking things up quickly. The Breastfeeding Network(BfN)- (declare my interest here, I am a BfN registered supporter). Their website: http://www.breastfeedingnetwork.org.uk/drugs-in-breastmilk.html which includes the BfN Drugline: 0844 412 4665. The Drugline is run by a BfN supporter who is a registered pharmacist, she does this on a voluntary basis. The BfN website is very user friendly and a good link to give mums. Another site I use myself and direct mums and colleagues to is Jack Newmans website, and he will also answer questions via email. http://www.drjacknewman.com/. The book I use the most is Medications and Mother’s Milk Thomas Hale. Hale publishing.2010
Jo
Breastfeeding Counsellor
Thanks for this information, Jo. You have also mentioned to me in the past that some GPs have been reluctant to prescribe domperidone to augment breastmilk supply. There is an information sheet on this on the BfN site (http://www.breastfeedingnetwork.org.uk/pdfs/Breastfeeding_and_Medication_FAQs_March_2009.pdf) and I have also found a full text academic paper on this subject that doctors may like to read (http://canadianmedicaljournal.ca/cgi/content/full/164/1/17). We sometimes request GPs to prescribe it for mothers of preterm babies who are struggling to keep up their supplies when expressing. It is not licensed for enhancing breast milk supply; http://tripanswers.tripdatabase.co.uk/Answer.aspx?qid=1929 summarises the situation and the recommended doses nicely.
I do find that Domperidone can make a big diference to the milk supply when used appropriately, ie mum must be fully breastfeeding effectively and/or expressing as well, so good breastfeeding support is essential. It is rarely effective unless the breastfeeding problems have been addressed as well.
I was discussing useful websites with my BfN colleague Wendy Jones and she also recommends Tom Hales site http://www.infantrisk.com/. It’s very user friendly, and I thought the information on Alcohol and Breastfeeding – something I am frequently asked about as mothers get so much conflicting, not evidenced based information – was very straightforward, clear, concise and easy to explain to a mother. Wendy is also developing a site on breastfeeding and medication, I will post details when it is live.
A useful breast feeding resource used by Medicines Information pharmacists is http://www.ukmicentral.nhs.uk/drugpreg/guide.htm It is quick and easy to understand/interpret. If, however you cannot find what you are looking for, or you would like a second opinion, please feel free to contact the Whipps Cross Medicines Information Department on 020 8535 6920, Monday to Friday, 9am-5pm. This service is run by clinical pharmacists, and has access to a variety of up to date reputable resources/databases. Please be prepared to provide relevant background information, as it is necessary to ascertain the full clinical picture before dealing with the query.
Farrah Khan
Lead Pharmacist
Women, Children and Medicines Information
Whipps Cross University Hospital NHS Trust