I've heard a lot of unhappy stories about medication advice given to nursing mothers. I hear about mothers told to wean or pump and dump unnecessarily, having health care providers not bother to look up medications or even read package inserts before making recommendations, or having their concerns dismissed. Recent research confirms what I've seen.
Someday this will change, I hope, but until then I think every nursing mother should know about these resources:
1) Medications and Mothers' Milk, by Dr. Thomas Hale, professor pediatrics at Texas Tech University. His book is the most comprehensive and up to date source of information available. This is a physician/pharmacist's reference book, but it's quite readable and clear. Dr. Hale gives each drug a rating of L1 to L5, discusses the available research about each drug, lists the half life and the time when a drug is at its peak in our blood, and notes the AAP rating and any pediatric or maternal concerns. The introduction to the book has a good summary of how medications transfer - and don't transfer - into breastmilk. Dr. Hale updates this book every two years.
This book is expensive, so I wouldn't expect mothers to buy it, but I would recommend that mothers make sure that their providers have and consult it. Many lactation consultants and La Leche League Leaders have copies, too.
Dr. Hale also runs a website with a searchable forum for health care providers. Mothers can read the forum but can't pose questions. I've found that it works best to use Firefox to view it. His website also has a very readable explanation of medications and transfer into breastmilk.
2) LactMed is a free, searchable database of medications and breastfeeding run by the National Institutes of Health. It provides information on effects in breastfed infants, effects on nursing mothers, the AAP rating of the drug, and alternatives to consider. In my experience the information hasn't been as comprehensive as Medications and Mothers' Milk, but it's still a great, quick, free source of information. Again, it's one that your providers should know about.
3) Kellymom.com has a good page which lists medications by topic (acne, cold remedies, dental work). She has also created a table with a list of medications with the AAP rating and Dr. Hale's rating, based on 2004 data.
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