Information resources for advice on medicines and breastfeeding

Using our advice

Before looking at these resources, ensure you are familiar with our guidance for managing a patient who may require medicines whilst breastfeeding.  This includes asking the right questions and conducting a risk assessment.

• Why breastfeeding is important and how pharmacy can help
• Questions to ask when giving advice on medicines and breastfeeding
• Advising on medicines during breastfeeding

SPS Breastfeeding resources

SPS have published advice relating to a wide range of medicines (SPS page) use during breastfeeding.

This has been produced by our specialist advisory service UK Drugs in Lactation Advisory Service (UKDILAS) (SPS page) and is based on evidence taken from multiple sources, pharmacokinetic principles and our expert opinion.

Further information

If the information is not available on the SPS website or the information resources listed below, or your clinical scenario is complex, seek further advice from UKDILAS (SPS page).

 

Our key additional resource suggestions

In addition to our own SPS resources, we particularly recommend the following.

If one of these resources recommends avoiding a medicine during breastfeeding, we would advise checking another resource or contact UKDILAS (SPS page).

e-lactancia

• e-lactancia is a Spanish resource with an English website version.
• Wide coverage of products with concise entries including a lactation risk category.
• Suitable alternatives are given where available.
• Relevant pharmacokinetic data is also available.

LactMed

• Lactmed is part of the US National Library of Medicine website.
• It is considered a reputable and up to date resource although not all medicines are included.
• Provides a thorough review of the evidence that is available.
• Also provides information on whether the medicine affects the lactation process itself.

NHS website: Medicines A-Z

• The NHS Website: Medicines A-Z provides patient-facing material.
• It contains information on a wide range of commonly used medicines, including over the counter medicines.
• Each medicine webpage has a section on breastfeeding in patient-friendly language, written by UKDILAS.

Medications and Mothers’ Milk (Hale) (Subscription required)

• Hale is considered a reputable and up to date US reference source.
• It is particularly useful for breastfeeding related pharmacokinetics and infant monitoring.

Other resources

Additional resources you might come across when answering questions about medicine use in breastfeeding.

If one of these resources recommends stopping breastfeeding or avoiding a medicine during breastfeeding, we would advise checking another resource or with UKDILAS (SPS page).

BNF

• The BNF statements on use of medicines during breastfeeding are brief and may be based largely on SmPC statements.
• As such, some information can be over cautious.

BNF for Children

• In some circumstances it may be helpful to check the BNF for Children to see if the medicine can itself be used in neonates or infants.
• This can provide reassurance of use in the paediatric population and useful dosage comparisons.

Breastfeeding Network (BFN)

• The BFN is a UK charity which provides support for families around breastfeeding in general
• It also has a helpline for medicine use in breastfeeding.
• The website includes factsheets on some medicines and common conditions in breastfeeding.

Briggs’ Drugs in Pregnancy and Lactation

• Briggs is a US publication with information about medicines during both pregnancy and lactation.
• The pregnancy information dominates each monograph with limited information on breastfeeding.
• The level of detail is not usually sufficient or helpful for Briggs to be used as a resource for medicines in breastfeeding.

Clinical Knowledge Summaries

• NICE Clinical Knowledge Summaries (CKS) include some guidelines advising on the management of conditions that may occur in breastfeeding mothers:
  • Post-natal depression
  • Mastitis
  • Hypertension (post-partum)
  • Smoking cessation
• There is also a specific guideline on breastfeeding problems.

Electronic Medicines Compendium

• The Electronic Medicines Compendium (eMC)  contains Summaries of Product Characteristics (SmPCs) and Patient Information Leaflets (PILs).
• This information clarifies the licensed status of a medicine’s use during breastfeeding and is not clinical advice.
• Manufacturers generally take a very cautious approach because of a lack of data.
• These should not be used as a sole information source for these types of medicines-related question.

Medicines Learning Portal

• The Medicines Learning Portal is produced by the UK Medicines Information network (UKMi) and provides clinical problem-solving training aimed at early career pharmacists:
• We recommend this to support the training of the pharmacy team.
• It contains a tutorial on medicines in breastfeeding written in conjunction with UKDILAS.

Unicef UK: The Baby Friendly Initiative

• The Unicef Baby Friendly Initiative contains an interesting evidence section on the benefits of breastfeeding to the mother and the infant, and advice on breastfeeding support in general.
• It also outlines the Baby Friendly Initiative Standards and learning outcomes for pharmacy students..

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