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| ==Background==
| | #REDIRECT[[Pregnancy and lactation drug labeling]] |
| Knowing what medications to prescribe is difficult and requires weighing all risks and benefits, but prescribing medications for a breast-feeding mother add another patient to the equation. Not only are there risks and benefits of medication use for the mother, but the provider and patient must also weigh the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. Although many drugs are safe during pregnancy, many are not considered safe for the nursing infant.
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| ==Mechanism==
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| Drugs enter milk primarily by diffusion, but also by secretory methods. They pass from the maternal plasma compartment through the capillary walls into the alveolar cell lining the milk buds. In most instances, the most important determinant of drug penetration into milk is the mother's plasma level.<ref>Hale, Thomas. "Medications and Mothers’ Milk", 15th
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| Edition. Pharmasoft Medical Publishing, 2012.</ref>
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| The amount of drug excreted into milk depends on a number of kinetic factors: 1) the lipid solubility of the drug, 2) the molecular size of the drug, 3) the blood level attained in the maternal circulation, 4) protein binding in the maternal circulation, 5) oral bioavailability in the infant, and the mother, and 6) the half-life in the maternal and infant's plasma compartments.<ref>http://www.infantrisk.com/content/drug-entry-human-milk</ref>
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| ==Categories==
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| {| class="wikitable"
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| ! Category !! Interpretation !! Details
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| | L1 || Safest || Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
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| | L2 || Safe || Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
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| | L3 || Possibly Safe || There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible, or controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. (New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.)
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| | L4 || Possibly Hazardous || There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
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| | L5 || Hazardous/Contraindicated || Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.
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| ==See Also==
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| *[[Drug Ratings in Pregnancy|Pregnancy Rating]]
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| ==External Links==
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| *http://www.infantrisk.com/content/drug-entry-human-milk#sthash.tl0C7KFM.dpuf
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| *http://kellymom.com/bf/can-i-breastfeed/meds/lactation_risk_cat/
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| *Armstrong C. "ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation". Am Fam Physician. 2008 Sep 15;78(6):772-778. [http://www.aafp.org/afp/2008/0915/p772.html]
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| *Spencer J. "Medications in the Breast-Feeding Mother". Am Fam Physician. 2001 Jul 1;64(1):119-127. [http://www.aafp.org/afp/2001/0701/p119.html]
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| ==References==
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| <references/>
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| [[Category:Pharmacology]]
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