Drugs and breastfeeding: The knowledge gap

Abstract

Because data describing drug excretion into human milk are generally lacking, pharmacokinetics (PK)-based prediction of infant drug exposure levels is clinically meaningful. Such PK-based prediction indicates that drugs with relatively low clearance (<1 ml/kg/min) in adults should be used with caution during breastfeeding, because their use may lead to relatively high levels of infant exposure due to even lower clearance in the infant. Complementing the PK-based prediction, a comprehensive, up-to-date information resource such as LactMed has proven useful. Given the established health benefits of human milk, ranging from anti-infective activity to enhancement of cognitive function in the infant, careful and individualized risk assessment is justified. However, when translating available knowledge into practice, it is important to recognize that risk-benefit balance in drug safety during breastfeeding varies among in different socioeconomic settings, as exemplified in anti-HIV treatment for lactating women.