Drug inserts or prescribing information leaflets of most of the commonly used drugs would mention a restriction during both pregnancy and breastfeeding, despite a lack of scientific evidence to support such contraindication. This defensive information is usually given to avoid any possible litigation. Very few companies would rightly mention it as “As directed by Physician” on their labels.
Most of the drugs pass into breastmilk, but the known adverse effects in infants are relatively few. The actual amount of drug secreted in breastmilk rarely exceeds the relative infant dose (RID) of 1 percent of the mother's dose, which is significantly less than the upper limit of safety, that is 10% of the maternal dose.
Moreover, the side effects described are for an Exclusively breastfed infant. So the relevance of these effects for an infant who is not on Exclusive breastfed or for an older infant when semisolids and solids have already been started, is even less significant. And the mother should be counselled accordingly.
Counseling a mother and assessing the safety profile of a drug in breastfeeding requires investment by health professional in terms of time, specific scientific knowledge, and an empathic approach. Health professionals should use the most authoritative information source that provide pharmacological and toxicological information. "LactMed" is a very reliable source for this and is free to access on web and has Apps for Mobiles too which often prove handy.
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