Most Medications OK During Breast-Feeding
Mothers may be able to take needed drugs while nursing
"If you pick up any package insert, you see the same language: 'There are no data available on this drug. Do not use in breast-feeding mothers,'" Hale said.
He said he was recently invited to give a presentation to the FDA committee developing the new drug labels. The first slide he put up was a picture of the blanket caution from the label of the antidepressant drug Zoloft (sertraline).
But in the case of Zoloft and many other drugs, he said, that's not the whole story.
Hale said 60 breast-feeding mothers who were taking Zoloft and their babies have been studied. "We knew exactly how much got into milk and it was almost nothing," he said. And that's just one example.
"We now know the risk of untreated depression is far, far worse than the risk of taking a drug," he said.
The report refers women and their doctors to LactMed, a database of information on the transfer of drugs to breast milk maintained by the U.S. National Library of Medicine.
LactMed contains information on more than 450 drugs, a fraction of the roughly 3,000 unique pharmaceuticals available. That's because other medications have not been studied in breast-feeding women.
Hale said even when specific lactation studies haven't been done, doctors can still make educated guesses about whether a drug will pass into breast milk and whether it will harm a baby, based on the size of the molecule and other chemical properties of the drug.
Doctors also should consider the length of treatment -- the risks of short-term therapy versus long-term therapy -- when making a determination about drug use, the report said.
There are some clear cases where medications can harm nursing infants. Radioactive compounds that are used as contrast agents in imaging studies or in cancer treatments require at least a temporary cessation of breast-feeding, according to the report. For that reason, elective imaging procedures should be delayed until a woman is no longer nursing.
Some narcotic pain relievers, including codeine, oxycodone (Oxycontin) and propoxyphene (Darvon), have caused serious problems in breast-fed infants. For that reason, the report suggests doctors steer clear of prescribing narcotic painkillers for nursing moms. Medications such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol) and naproxen (Aleve) may be safer choices for pain relief.