Abstract
BackgroundHealth professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice.MethodsA random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with “BREASTFEEDING” in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used.ResultsIn the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly (p < 0.05) more likely when the enquirer was a physician.ConclusionsThis analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug.
Highlights
Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs
The drugs for each Question-answer pair (QAP) are registered according to their generic name, trade name and the ATC-number according to the Anatomical Therapeutic Chemical (ATC) classification developed by the World Health Organization [10]
To obtain a random sample of 100 QAPs we excluded 17 QAPs based on the following exclusion criteria: nine questions were not about evaluating compatibility of a drug with breastfeeding, six questions were from patients and two questions were about exposure to supplement and recreational substance, rather than drugs classified within the ATC-system
Summary
Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Health professionals often give women advice to cease breastfeeding because of a restrictive attitude and biased risk perception towards use of drugs in lactation [1,2,3]. This could stem from a lack of knowledge among health professionals regarding this topic, not having access to good sources of information or using sources that do not provide evidence-based information [1, 2]. The compendium contains monographs for each product with a particular section concerning pregnancy and breastfeeding Warnings in this source are likely caused by lack of clinical studies investigating the exposure of newborns to drugs through mother’s milk. The Norwegian Pharmaceutical Product Compendium is extensively used as source of drug information by Norwegian general practitioners [5], and the warnings could raise concern among health professionals
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