Common herbal products are also included. LactMed includes up-to-date information on drug levels in human milk and infant serum, possible adverse effects on breastfeeding infants, potential effects on lactation, and recommendations for possible alternative drugs to consider. A more comprehensive and current database is available at LactMed ( ). Revisions for the statement can no longer keep pace with the rapidly changing information available via the Internet, published studies, and new drug approvals. 6 Previous editions were intended to list drugs potentially used during lactation and to describe possible effects on the infant and/or on lactation. In large part because of efforts by Cheston Berlin, Jr, MD, a statement by the American Academy of Pediatrics (AAP) on the transfer of drugs and chemicals into human milk was first published in 1983 3 and underwent several subsequent revisions, 4, 5 the most recent of which was published in 2001. 2 In the near future, pharmacogenetics may also provide important guidance for individualized decisions. The age of the infant is also an important factor in the decision-making process, because adverse events associated with drug exposure via lactation occur most often in neonates younger than 2 months and rarely in infants older than 6 months. These factors include the need for the drug by the mother, the potential effects of the drug on milk production, the amount of the drug excreted into human milk, the extent of oral absorption by the breastfeeding infant, and potential adverse effects on the breastfeeding infant. To weigh the risks and benefits of breastfeeding, physicians need to consider multiple factors. In addition, not all drugs are excreted in clinically significant amounts into human milk, and the presence of a drug in human milk may not pose a risk for the infant. 1 Such advice is often not based on evidence, because information about the extent of drug excretion into human milk may be unavailable, and for many drugs, information is limited to data from animal studies, which may not correlate with human experience. Many women are advised to discontinue nursing or avoid taking necessary medications because of concerns about possible adverse effects in their infants. Lactating women can be exposed to medications or other therapeutics, either on a limited or long-term basis, depending on the need to treat acute or chronic conditions. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see ). A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed ( ). Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants.
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