Nursing mothers get bad information at the pharmacy counter.

Last year a study proved something many of us have found out the hard way:  much of the information nursing mothers get at the pharmacy counter is inaccurate.  According to the Massachusetts Breastfeeding Coalition:

The study's authors examined the safety information used by two large retail pharmacy chains on the East Coast, looking at 14 commonly-prescribed medications. For 75 percent of drugs that are considered unequivocally safe for breastfeeding, pharmacies were inappropriately advising mothers to stop nursing.

"We were surprised by the results, when we looked at all the resources systematically," said lead author, Monica Akus, PharmD, a pharmacist at Cambridge Health Alliance and Assistant Professor of Pharmacy at University of Rhode Island. Several well-respected sources used out of date information, most commonly resulting in inappropriate advice to stop breastfeeding. "As pharmacists, our training in drugs and lactation is often limited, so it's critical to spread the word to other pharmacists. Our knowledge is only as good as our resources," notes Akus.

The authors consider two resources to be the most reliable:

• LactMed, is a website run by the National Institutes of Health which you can use to look up medications and their impact on breastfeeding.
• Medications and Mothers Milk, by Dr. Thomas Hale (2008 edition coming out soon).  I use this book a lot and find its "L1 to L5" scale of rating drugs very helpful. 

Have you received bad information at the pharmacy counter?  Were you told that a medication was unsafe when it wasn't, or safe when it was unsafe?  Tell us about it below.

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Comments

[Jen Robinson]

This happens all the time. They do it to be safe because so many of the studies are not done with women who are pregnant and/or nursing. Most recommendations are based on information gained after the fact. In other words, the studies were done and there was no evidence either way and then based on reports (or lack thereof) of children having problems during or after their lactating mothers took the drugs, a rating of safe or unsafe is given.

Most drugs fall into the categories of A, B, or C - meaning totally safe, considered safe - tested with little or no known side effects, or considered safe but use caution (i.e. lower dosages, etc.) because the jury is out. The last category is unsafe all the time.

The best way to know is to always ask your doctor. I take antidepressants and because I was trying to get pregnant when I started taking them, I was given the most mild med and the lowest dose possible. When I went to the pharmacist the info that I was given said not to take during pregnancy or while breast feeding. I took my antidepressants throughout my pregnancy and repeatedly had to tell the pharmacist that it was ok for me to take the meds because I had already discussed it with my doctor. My daughter was fine and I had no complications during my pregnancy whatsoever.

I recently started a different medication because my insurance no longer covered the one I was taking and the generic (which they do cover) didn't work for me. My first question to my doctor was if there would be any problem with nursing or pregnancy while on this drug.

The bottom line is that women need to become more vocal with their doctors about their medications in regard to nursing and pregnancy. A doctor can't read your mind to know if you're trying to get pregnant or if you're nursing a toddler (it's not always as obvious if you don't have an infant) or if you're nursing at all. It is the patient's responsibility to speak up and give the doctor the most information possible.

We should not be relying on pharmacists who, while well-trained in their field to recognize potential drug interactions, are not physicians and aren't trained to be well-versed on all of the effects of certain drugs on the human body given the diversity of the patient population. Any doctor can look up the information if s/he doesn't know the answer to "Will this be okay to take while nursing?" and if s/he won't look it up it's time to get a new doctor.

[Ella]

I am commenting on Jen's 4/17 comment. I doubt, as a group, that prescribing physicians/PAs/nurse practitoners, etc. would do better than pharmacists if a similar study was done with them. I was pretty shocked at this post because I assumed a pharmacist would be more knowledgable about meds and breastfeeding. They are the medication specialists afterall. I have had very bad experiences with physicians who simply shut down if breastfeeding is mentioned. They automatically say stop breastfeeding or don't take the meds - without research.

Since I now know that the majority of medications are safe during breastfeeding, I have decided to be "demanding". I ask what would the recommendation be if I was not breastfeeding and then I demand specific details on why this would be contraindicated in breastfeeding. If you ask the second question, you'll find out if the physician is being "safe" (and lazy, really) due to ignorance or if they have a legitimate concern with the treatment.

[onetinkerbell]

Just an addendum to my comment and a response to Ella's comment.

My husband is a PA and is in med school getting his MD. We spend most of our "social life" (what little there is) getting together with medical practitioners (nurses, PAs and MDs of various specialties). I have encountered many different medical providers during my husband's 12-year (so far) Army career, given that it's almost guaranteed that you won't get the same provider twice in a military medical facility, although it can happen. Many of my husband's family members are also MDs or PAs. My comments are based on their reactions to the subject and those reactions are based on their specific patient-doctor interaction, as well as on my own experiences.

Specifically my experiences are based on observations that other docs and PAs have made to me - to whit: I wish all of my patients were as forthcoming and informative as you are.

If the majority of American women have physicians that aren't changing every 12 to 18 months the way they often do at military medical facilities (or even more frequently) then they should be able to develop a rapport with their physician and be able to become advocates for their own health care issues.

That is not to say that pharmacists can't give appropriate advice but rather that they generally aren't allowed to because they are not medical providers and don't have a patient's medical history in front of them. More to the point, they aren't doctors! Patients don't come to them if they have a reaction to a certain medication, they go to their doctors.

If you have a doctor who is unwilling to discuss breast-feeding with you then he or she doesn't have the patient's best interests at heart and you need to find a new doctor or at least a different one within the practice that you frequent. This is also part of being an advocate for your own health. I have seen far too many women just dealing with a medical problem because they weren't acting as advocates for their health and didn't bring up issues with their providers. This goes beyond breast-feeding. It's about health in general. As women we need to be familiar with our own bodies, know what is normal and what is not and act accordingly.

Ella, this is clearly what you have chosen to do and it's exactly what the rest of the population needs to do as well. As an individual there's no one else who can want the best for me besides myself. The same goes for every woman out there. A lack of knowledge can hurt you, and it's been my experience that the only dumb question is the one you don't ask.

[rachel]

I asked a pharmacist at a stop and shop about what meds I could take and she didn't even try to help. She just told me to ask my doctor. Then I went to a Brooks pharmacy and the pharmacist was a young man who went with me in the aisles and looked up a bunch of medications for whether they were A B C.