I have a 1-year old infant in my practice whose mom has Multiple Sclerosis.
The mom has done wonderfully with the baby and the baby is nursing well (as
well as eating table food, etc., of course) and neither mom nor baby is ready
to wean.

The neurologist wants to give Mom Avonex (beta interferon) and told mom he
wouldn't/couldn't use it on her if she was nursing.  I called him and told him
that this drug would present NO problem with breastfeeding, as it is too large
to cross into the breastmilk, and to please go ahead and treat the mom.

He was very hesitant to accept my advice, as he had used the PDR as his
reference, and was worried about any legal risks of giving the drug if he went
against the PDR recommendation.  I informed him that the PDR was of no
practical use in ascertaining the safety of any medication with lactation, and
sent him information from Hale 98-99, a copy of the AAP statement on drugs in
breastfeeding, a copy of the information from Hale's website, and a note
summarizing the Avonex discussion on Lactnet in January 1998 by Hale and Nice.

My problem is this:  the neurologist got a packet of stuff from the Avonex
manufacturer and is refusing to treat the mom still.  Mom would likely benefit
from being treated for her MS and I know the treatment won't be a problem for
the baby and there's no need for weaning.  What can I do to convince him that
it's OK to treat this mom with Avonex (beta interferon) while she is
breastfeeding?  Any ideas from any of you lactnuts?  Help!

Linda L. Shaw MD FAAP