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Specialist Services | Drugs in lactation

Drugs in lactation

Medicines in lactation specialist advisory service

Introduction

The Trent and West Midlands Medicines Information Centre have provided advice and support for enquiries relating to the use of medicines in lactation since October 1975.  The centres are jointly staffed by 12 pharmacists experienced in providing medicines information.  The service is provided under the title of the UK Drugs in Lactation Advisory service (UKDILAS).

 

The types of enquiry answered include:

  • Excretion of drugs, diagnostic agents and chemicals into breast milk.
  • Effect of medicines on milk composition.
  • Effects of medicines on milk production, including the enhancement and suppression of lactation.
  • Risk assessment for breastfed infants exposed to maternal medication via breast milk.
  • Risk differentiation between full-term, preterm and health-compromised infants.
  • Selection of medication in lactation in specific disease states.
  • Management of breastfeeding-related conditions, e.g. pain, nipple/breast infections, engorgement etc.

Who can use the service

The service is provided to all health care professionals but is primarily used by nurses, midwives and doctors working the related fields of obstetrics, paediatrics and post-natal care.  It is also available to breastfeeding counsellors, La Leche League and other breastfeeding support organisations.  Advice and support is also provided to medicines information pharmacists.  Non MI pharmacists are advised to contact their local MI pharmacist in the first instance except for breastfeeding support organisations.

 

How to make enquiries

UKDILAS is available during the centres’ main opening hours - 09:00 am until 17.00 pm,  Monday to Friday, excluding Bank Holidays.

To contact the service:

Information required when making an enquiry

  • Patient specific or general enquiry
  • Age of infant (gestational age if premature)
  • Status of infant – healthy/morbidity. Any additional risk factors e.g impaired renal/liver function, respiratory depression
  • Maternal and infant drug(s) including route of administration, dose, frequency and duration of therapy (include OTC and dietary supplements, herbal preparations etc)
  • Has mother already taken the drug(s)
  • Have any other alternatives been tried or considered?
  • Sources already checked
  • Details of person raising the enquiry – patient, doctor, health visitor.

Medicines information pharmacists should have looked in standard medicines information reference resources before calling the service e.g. Medicines Q&As, Hale’s  Medications and Mother’s Milk (Hale/Medilact;), LactMed (NLH), UKDILAS guidance at www.ukmi.nhs.uk/ukdilas

 

Sources of Information

The centre has access to a wide range of standard medicines information textbooks, journals and databases plus specific lactation resources.  However, information from the published literature is not used in isolation and practical experience is available from specialist practitioners and organisations.  We also maintain a large database of previous enquires.

Lactation textbooks:  Current editions of the following:

  • Breastfeeding and diseases.  Buescher ES, Hatcher SW
  • Breastfeeding. A guide for the medical profession. Lawrence RA and Lawrence RM
  • Clinical therapy in breastfeeding patients.  Hale TW, Berens P.
  • Drug therapy & breastfeeding - From theory to clinical practice. Hale TW, Ilett F.
  • Drugs and human lactation.  Bennett PN.
  • Drugs during pregnancy and lactation.  Schaefer CM, Peters P, Miller RK.
  • Drugs for pregnant and lactating women.  Weiner C, Buhimschi C.
  • Drugs in pregnancy and lactation.  Briggs GG, Freeman RK,Yatte SJ.
  • Herbal medicines in pregnancy and lactation. An evidence-based approach.  Mills E, Dugoua J-J, Perri D, Koren G.
  • Medications and mothers milk.  Hale TW.
  • Non prescription drugs for the breastfeeding mother.  Nice FJ.
  • Textbook of human lactation.  Hale TW, Hartmann PE.

On-line sources

Journals
  • Journal of Human Lactation
  • International Breastfeeding Journal
  • Breastfeeding Medicine

Liaison with:

  • Medical and nursing specialists
  • Research specialists
  • Voluntary and self-help organisations, e.g. La Leche League, International Lactation Consultants, National Childbirth Trust.

Guidance

The centre has prepared the following guidance documents


MS Word File  Domperidone statements 
MS Word File  S00003-Domperidone 

Standard search strategies for drugs in lactation/breast milk using Medline or Embase

MEDLINE

EMBASE

1

MILK, HUMAN       [Map to thesaurus]

BREAST MILK      [Map to thesaurus]

2

LACTATION          [Map to thesaurus]

LACTATION          [Map to thesaurus]
OR LACTATION INHIBITION OR MILK EJECTION OR MILK PRODUCTION

3

BREAST FEEDING  [Map to thesaurus]

BREAST FEEDING    [Map to thesaurus]

4

(Breast AND milk) OR Breast-milk OR (Human AND milk) OR Lactati*4

5

(Breast AND feed*3) OR (Breast AND fed) OR Breastfeed*3 OR Breastfed OR Breast-feed*3 OR Breast-fed                                                    .ti,ab

6

1 OR 2 OR 3 OR 4                                                                    [Limit to: Humans and English Language]

7

DRUGNAME                                                                              [Map to thesaurus]

8

Drugname OR drug name                                                    .ti,ab

9

6 AND (7 OR 8)