The use of medicines in breastfeeding mothers requires significant assessment of risk verses benefit. The following are points of consideration when medicines are required during breastfeeding:
Concerns of maternal medicine use are greater when the breastfeeding infant is a newborn or premature. This is because a premature infant’s capacity to metabolise and excrete medicines is less efficient compared to an older infant/child.
Medical conditions in the breastfed infant should also be considered, particularly when the rate of medicine excretion is altered due to impaired renal or hepatic function.
In general, when infants are exposed to medicines via breast milk, the amount of medicine is significantly less compared to in utero exposure via the placenta.
Medicines usually enter breast milk by passive diffusion driven by the equilibrium forces between maternal plasma compartments and the breast. However, active transport carriers on the breast cell membranes can actively pump medicines into breast milk.
Factors that determine how well a medicine can pass through into breast milk are lipid solubility, molecular size and protein binding
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Summarises key findings and provides detailed, practical recommendations on the use of medicines during pregnancy and breastfeeding to support the clinical decision making process
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The Therapeutic Goods Administration (TGA) pregnancy categories and manufacturer’s product information are sometimes difficult to interpret. The Women’s PBMG has developed a series of practical recommendations for medicines used during pregnancy and breastfeeding.