SPS Breastfeeding resources

Breastfeeding Medicines Advice service service (UKDILAS) is our specialist advisory service and produces medicines specific advice during breastfeeding, which provides directive answers and should be your initial source of reference.

It includes advice on individual medicines therapeutic groups, as well as more detailed information on our most frequently asked questions.

This resource will provide you with all the information you need in the majority of cases, as we have based our advice 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 your clinical scenario is complex, seek further advice from our Medicines Advice service or Breastfeeding Medicines Advice service service (UKDILAS)

Our top additional suggestions

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

e-lactancia

• e-lactancia is a Spanish website with an English version provided.
• Wide coverage of products with succinct entries including a lactation risk category. Some monographs have short additional notes.
• 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:

• We particularly recommend this for patients and for patient-facing material.
• It contains information for patients on a wide range of commonly used medicines, including over the counter medicines.
• Each webpage for an individual medicine has a section on pregnancy and breastfeeding in patient-friendly language, written by UKDILAS, our specialist advisory service.

NICE 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)

There is also a specific guideline on breastfeeding problems.

Other breastfeeding resources

We have provided our views on determining the limitations (if any) of additional resources you might come across when answering a lot of questions about medicine use in breastfeeding.

BNF

• The BNF statements on use of medicines during breastfeeding are brief and may be based largely on SmPC statements.
• As such, the information is generally 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 as this provides reassurance of use in the paediatric population.

Breastfeeding Network (BFN)

• The BFN is a UK charity which provides support for breastfeeding in general, including a helpline accessed via Facebook.
• The website includes patient leaflets on some medicines, however the advice does not appear to be sufficiently evidence-based.

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 lactation.
• The level of detail is not usually sufficient or helpful for Briggs to be used as a resource for medicines in breastfeeding.

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.

GP Infant Feeding Network

The GP Infant Feeding Network supports quality improvement in the field of infant feeding:

• We recommend this to find out more about best practice in healthy infant feeding in general, including breastfeeding.
• It gives practical advice on feeding related issues, e.g. mastitis, candida infection, vitamin D supplementation.

Medications and Mothers’ Milk (Hale)

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

Medicines Learning Portal

The Medicines Learning Portal provides clinical problem-solving training:

• We recommend this to support the training of the pharmacy team.
• It contains a tutorial on breastfeeding written in conjunction with Breastfeeding Medicines Advice service service (UKDILAS).

Unicef Baby Friendly Initiative

• The Unicef Baby Friendly Initiative contains an interesting evidence section and advice on breastfeeding support in general.
• It also outlines the Baby Friendly Initiative Standards.

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