Questions to ask when giving advice on medicines and breastfeeding

Vanessa Chapman, Director, Midlands and East Medicines Advice Service (East Midlands site) & UK Drugs in Lactation Advisory ServicePublished

This page provides advice on the types of questions to ask a mother or another health-care professional who is seeking pharmacy input on the safety of medicines during breastfeeding. It may help those new to giving advice in this area who need to advise mothers in a timely manner. Remember that withholding breastfeeding and/or expressing breastmilk are not easy, practical, or risk-free options for the mother and infant.

You may also be interested in our other pages in this area: Medicines specific advice during breastfeeding, Why breastfeeding is important and how pharmacy can help, Advising on medicines regimens during breastfeeding and Information products that give advice on medicines and breastfeeding

We have created a template at the bottom of this page which enables you to to download the following questions and record responses during discussions with mothers or others. This can then be uploaded to a person’s medical record.

Which medicine(s) is the mother taking?

Remember to include over the counter medicines, complementary medicines and supplements.  Check for the duration of therapy and if the mother is actually taking what has been prescribed. This will allow you to check whether all medicines are suitable or if there are any interactions.

Is the mother already taking the medicine or is it something that is newly prescribed?

You may be considering two or more medicines or be willing to use an alternative.  If you find that one of the options is unsuitable in breastfeeding, recommending a preferred alternative is more feasible if the mother hasn’t already been taking the medicine.

If a mother is already established on a medicine, switching to an alternative because of breastfeeding may not be a suitable clinical option for the mother.

For example, you may be much more willing to accept a change to an antiepileptic medicine if it is being used for neuropathic pain as opposed to its use for epilepsy.

Has the mother taken the medicine during pregnancy?

Some medicines may be started, stopped or switched during pregnancy.  It cannot be assumed that a medicine that was safe or unsafe during pregnancy will be so during breastfeeding.

A separate risk assessment for the use of a medicine in breastfeeding is still required.

Is the infant at increased risk of harm from a medicine (e.g. kidney or liver dysfunction)? Are they prescribed any medicines themselves?

It is just as important to take a full medical and drug history of the infant.  Their ability to excrete medicines they are exposed to via breastmilk, or their medical condition(s), may be affected or aggravated by the side-effect profile of the medication they are being exposed to via breastmilk.

How old is the infant?  Is he/she premature or full-term?

The handling of medicines is completely different between, for example, a premature infant born at 28 weeks gestation, compared with a two year old infant who may still be having comfort feeds.

Is the infant exclusively on breastmilk?  How often is the mother breastfeeding?

Infants are weaned onto solid foods at around six months of age.  Advice and any potentially mitigating factors will be very different for a newborn infant being fed on demand compared with an older infant having night-time comfort feeds.

Exposure to medicines in breastmilk is greatest for infants who are exclusively breastfed. If an infant is being part formula fed, or started on solids, this reduces the overall medicine exposure.