Drug distribution in human milk

Kenneth F. Ilett, Judith H. Kristensen

Aust Prescr 1997;20:35-40

Summary

Assessing the safety of breast feeding during maternal drug therapy is an individualised risk:benefit analysis. An infant’s exposure depends on drug transfer into milk, daily milk intake and the bioavailability of the drug in the infant. Exposure and the potential for adverse effects is greatest in premature neonates and decreases over the first few months of life as the infant’s clearance mechanisms mature. Risk should be assessed in the light of the inherent toxicity of the drug and any published data on milk transfer and infant exposure. When maternal drug therapy is necessary, the breast-fed infant should be regularly assessed for adverse effects such as sedation, failure to thrive and achievement of developmental milestones. Laboratory measurement of drug transfer into the milk and the infant’s blood should be used, where possible, to confirm suspected adverse effects.

Introduction
The distribution of drugs and environmental chemicals into human milk continues to be an important issue as the community becomes more aware of the possible risks to the breast-fed infant. There is general agreement that women taking drugs such as amiodarone, cytotoxic agents, ergotamine, gold salts, immunosuppressive agents, lithium, radiopharmaceuticals, phenindione, acitretin, etretinate and isotretinoin should not breast feed because of the drugs’ inherent toxicity. Questions are more likely to be asked about drugs which are commonly used during lactation. An understanding of pharmacokinetics can help the assessment of risk.

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