Breastfeeding

Question 1

Why is it important to consider the age of the breastfeeding child?

Answer 1

• the renal function rapidly improves in the first 2 weeks of life
• this is in term babies. Prem babies have much lower eGFR.
• Renal function effects a baby’s ability to effective clear a drug. Poor drug clearance = increased likelihood of adverse reaction

Question 2

Other than the age of the child what other things are important to consider when prescirbing a new medication to a breast feeding mother?

Answer 2

• other medication the mother takes
• how often the child is breast fed
• child’s comorbidities

Question 3

How do medicines enter the mother’s milk?

Answer 3

• mainly via diffusion
• blood plasma levels of drugs are roughly equal to milk levels of the drug
• ALSO drugs that cross the BBB enter the milk (rule of thumb, not absolute)

Question 4

What physiochemical factors reduce the liklihood of a drug entering the mother’s milk?

Answer 4

• high molecular weight (heparin, insulin)
• high protein binding (warfarin, NSAIDs)
• low lipid solubility (loratadine)
• lower pH drugs (amoxicillin) - breast pH is lower than blood plasma

Question 5

What vaccination cannot be given during breastfeeding?

Answer 5

yellow fever

the rest are all gravy

Question 6

What antibiotics can you give to a breast feeding mother with a UTI?

Answer 6

• amoxicillin
• cefalexin
• trimethoprim

NOT nitrofurantoin

Question 7

What analgesic options are their for breastfeeding women after adequate levels of paracetamol have been used?

Answer 7

NSAIDs are the next choice (ibuprofen & declofenac)
-weak acids + protein bound so pass into the breast milk in low concentrations

Definitely avoid codeine for it’s various rates of metabolism.
Use a different weak opioid if necessary and monitor baby for drowsiness, poor feeding and respiratory depression.
Tramadol is deemed safe in infants.

Question 8

What the recommended drug treatments for depression in a breastfeeding mother?

Answer 8

SSRI first line - sertraline and paroxetine
TCAs - second line
take into account previous response to treatment

Question 9

What do you have to advise a mother who is taking a pharmacological antidepressant?

Answer 9

• monitor the bab for drowsiness, poor feeding and respiratory depression anyway
• breast feed pre dosing to reduce passage to the child
• avoid breast feeding at peak blood concentrations of the drug (this varies for medications - usually 1-3 hours, could be 6-8)
• one breast feed can be replaced by a bottle feed at peak blood concentration times

Question 10

Which contraception is contraindicated after birth?

Answer 10

combined oral contraception is contraindicated up to 3/12 post-partum due to it’s tendency to reduced breast milk production

Question 11

Seasonal rhinitis how do you treat in breastfeeding women?

Answer 11

• don’t give sedating antihistamines
• give non-sedating antihistamines
• encourage topical treatments where possible
• No Tx is possible