Hi Lactnetters,
I am a hospital-based lactation consultant and faithful lurker.  I was
recently asked by our NICU Case Manager to review a video dropped off in
our department by the M-J- rep concerning drugs in lactation which
evidently comes with an offer for a complete inservice presentation by the
M-J- rep.  I had heard a bit of discussion about this on Lactnet  so  I'm
coming out of lurkdom to share my response which is, of course, just my
humble opinion....

I have reviewed the video "Drugs in Lactation" produced and distributed by
M-J- and my impressions are as follows:  I found the video a mixed bag of
fact, positive statements, and negative innuendo.  Though experts including
the American Academy of Pediatrics have advised that most medications are
compatible with breastfeeding, the tone of this video is quite the
opposite.

There are numerous positive images of mothers and babies, with
breastfeeding presented as the "ideal," and the explanation of factors
which determine how much of a drug ends up in the breastmilk is brief but
helpful.  However, the interesting fact that most drugs get into the
breastmilk at only 1% or less of the maternal dose was never mentioned--and
the advice given several times to take a drug immediately after
breastfeeding to avoid infant exposure may or may not be of value,
depending on the peak levels and half-life, and the frequency of feedings.

The short list of contraindicated drugs is covered well.  Then, concerning
drugs to be used with caution, one of the featured doctors/authors of a
popular reference on drugs in pregnancy and lactation has a downright
ominous tone, using words like toxicity and harmful, and emphasizing lists
of nasty side effects but does not make it clear if these side effects have
occurred through breastmilk or other exposure to infants.  For example, the
risk of alcohol use during pregnancy is totally different from lactation
because the alcohol will metabolize in and out of the breastmilk at the
rate of 2 to 3 hours per drink.  There is also no mention of recent
published research done by Dr. Katherine Wisner of the Cleveland Clinic
Mood Disorders Department on the relative safety of Zoloft for use with
breastfeeding moms, and the good track record of most tricyclics.

I take exception to this simplistic treatment of what is unsafe for a
mother to take.  Risk of weaning to formula must be weighed into the
equation, as well as the infant's age, and if the drug could be directly
given to infants, such as metoclopramide.  Most physicians do not agree
that a short course of Reglan for mom to boost the milk supply is risky for
the nursing infant.  It would be easy to conclude from the information
presented (and omitted) from this video that breastfeeding is just too
risky, and formula feeding is so much safer.

Because M-J- has a vested interest in the sale and use of infant formula, I
frankly question the motive behind their aggressive marketing of health
professional education on lactation issues.  It's like Ford doing promotion
for Chevy.  Why would they do that?  If "drugs in lactation" is a subject
that is thought to be important for our staff to spend time studying, I
would be happy to present an inservice on the most up-to-date information. 
I also recommend their perusal of MMM (copies are on the unit), a much more
current and specific reference, especially the introductory chapter which
explains the potential transfer of medications and the relative risks to
the infant. (end)

Our Case Manager told me today that she respects my opinion and that we
would not be taking part in this program.

Diane Bechtel, BGS, IBCLC