DRUG-THERAPY IN THE NURSING MOTHER

Recommendations to interrupt or discontinue nursing are far too preval ent among health care providers in the United States. Despite availabl e reference texts and drug information, physicians too often encourage discontinuation of breast-feeding rather than expend the effort to en sure that maternal treatment is, in fact, indicated, then select a dru g and dosage regimen that is compatible with breast-feeding. Health ca re providers are possibly unduly influenced by the well-known teratoge nic effects of a minority of drugs taken during pregnancy and are unaw are of the relative safety of the majority of maternal medications on the infant. They fear the potential of toxic effects of drugs in breas t milk as have been documented in a small number of well-described sit uations. However, their concern is unwarranted in most cases. In addit ion, many physicians are concerned about legal repercussions when they order medications for a nursing mother and because of this concern, t he tendency is to err on the side of caution. Except in rare cases in which underlying maternal illness requires treatment with medication n ot compatible with breast-feeding, thoughtful selection of medications can usually allow nursing to continue without fear or interruption. U ltimately, the decision to continue nursing and to comply with prescri bed medications lies with the mother; therefore, she should be educate d regarding the potential risks of nursing while taking a specific med ication. She should also be advised of the potential difficulties enco untered by herself and her baby when lactation is interrupted. In case s in which the mother desires to continue nursing and medical treatmen t poses a potential risk to the infant, the pediatrician should be inc luded in the decision, the mother instructed on signs and symptoms of toxicity, and the infant's serum drug levels monitored as indicated. T he American Academy of Pediatrics (AAP) committee on drugs has publish ed a list of drugs and other chemicals that transfer in human milk.(12 ) Briggs' Drugs in Pregnancy and Lactation(8) also serves as a readily accessible summary of many frequently prescribed medications.