Hi to All and thanks in advance for the help--
This came to my attention yesterday at change of shift, and I got our great
hospital pharmacist on the phone, but he is out today, and none of the other
pharmacists are as familiar with lactation issues.
  I have a breastfeeding patient who had a liver transplant and takes
Prograf (aka Tacrolimus).  Patient is determined to breastfeed and states
she discussed her meds with her perinatologists during pregnancy, and was
assured breastfeeding wd be OK.  Hale 2000 classifies this med as L4
(hazardous), which is one step shy of being contraindicated.  The info my
hospital pharmacist read to me off of his database included the fact that
this med is not used in infants under the age of 12 weeks because they do
not have the kidney / liver function to metabolize it.  I am copying Hale
for the mom, and I would love for her to have the other info as well, so she
can have good info upon which to base this decision.  When I discussed this
with the neonatologist who was on call yesterday, his thinking was that
since it is not contraindicated, we won't stop the mom from bfdg, but just
make sure she is well-informed, and this approach seems reasonable to me,
now I need more information.
  Dr Hale, are you out there?  Any other lac-minded pharmacists, or anyone
have clinical experience with a bfdg mother who has been on this med?
thanks to all from
MArtha Johnson RN IBCLC
Eugene Oregon
PS--
Please reply to me privately as well as to the list!

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