Clinical Common Sense
“Clinical common sense” is a term I mention almost every time I discuss medications and lactation. I’m pretty sure every healthcare professional heard this term or a variation of this term while attending their respective professional school. You may know what “clinical common sense” means, but this is my personal definition: someone applies common sense to all the clinical knowledge they have obtained from school, internship/residency, guidelines, and research before making a recommendation or deciding on treatment for the present situation.
When it comes to medications and lactation, I have found that many healthcare providers throw common sense out the window and only use their clinical knowledge. This is a problem if you have a provider who is not lactation-knowledgeable and uses inappropriate drug information resources. Unfortunately, this is a high percentage of healthcare providers, because most of us received little to no lactation education when in school. I have patients and clients who have more clinical common sense than some providers. To be clear, I’m not putting down other providers. I used to be lactation-ignorant myself, and I know I used to give out bad advice regarding medications and lactation. Now, I strongly feel that, given the inexpensive and readily available resources regarding medications and lactation, healthcare providers no longer have an excuse to give out bad and inappropriate advice.
Let’s look at a few examples of what I mean by “clinical common sense” so you are able to apply it to your own health situations in case your provider does not. I want you to be confident in your abilities to decipher between good and bad advice regarding medications and lactation.
Antibiotics are by far the class of medication that causes the most confusion. I can’t tell you how many times I’ve read, heard, or been asked about providers telling lactating individuals to pump and dump while taking an antibiotic. The majority of all antibiotics do not require pumping and dumping. Furthermore, many antibiotics prescribed to lactating individuals can be used safely in infants. This is what I mean by “clinical common sense.” In general, if a medication can be used safely in an infant, it makes no sense to tell a lactating individual not to nurse or give pumped milk while taking the same medication. However, it would be appropriate for a provider to discuss potential side effects for both the individual and the child, because sometimes babies/toddlers do have side effects from maternal medication use. For example, parents sometime see a change in stool consistency if the lactating individual is using a broad-spectrum antibiotic. An example would be dicloxacillin, a penicillin antibiotic commonly used to treat mastitis. A provider using clinical common sense would recognize that dicloxacillin is a penicillin antibiotic, and penicillin antibiotics can be used in very young infants. Therefore, dicloxacillin would be safe for a lactating individual to take and to continue nursing or pumping. However, I’ve had several providers in my area tell lactating individuals to avoid nursing or pumping while taking dicloxacillin. It’s obvious these providers are not using clinical common sense and/or they are not using appropriate references for medications and lactation.
Another class of medication that causes confusion is acid reflux medications. Zantac, or ranitidine, may be prescribed for acid reflux in infants and adults alike. I have some patients who have been scared to treat their own acid reflux, because they have been told Zantac is not safe to take during lactation. This makes no clinical sense, because why would something be safe for an infant to take directly but not safe for an infant to receive through breastmilk? Further research would show that the amount of ranitidine transferred through breastmilk would be below the recommended dose for treating acid reflux in infants.
There are some questions you can ask to determine if your healthcare provider has properly researched a medication before making the recommendation to pump and dump or to avoid a medication during lactation. You should first ask the provider to provide evidence for this recommendation. I am a huge believer that you should be able to provide a reference for any recommendation you make as a provider. Traditional medicine is based on scientific evidence, and you should not make a recommendation if you cannot back it up. LactMed and Infant Risk are the two primary medications and lactation references I use in practice. If your provider does not cite a reference specific to lactation, I would be wary of the recommendation. You can also ask if the medication is safe to use in infants and/or children. The provider can use any of their references to look up indications and dosing for a particular medication. If babies are safe to take the medication, you are generally safe to take it while lactating. Finally, if you want to double check your provider’s recommendation, you can call Infant Risk at 1-(806)-352-2519. Infant Risk is staffed by doctors and nurses who are able to provide you with accurate, up-to-date information regarding medications and lactation.
So, the TAKEAWAY: Clinical common sense is something every healthcare provider should possess. All healthcare providers want to provide the best care for their patients. However, lack of education and use of inappropriate resources has decreased many providers’ clinical common sense when it comes to medications and lactation. In general, if an infant can take a medication directly, there is no reason to tell someone to avoid the same medication in lactation. Healthcare providers need to use appropriate resources to determine if a medication is safe during lactation. If your provider gives you bad information, you can research the medication yourself by calling Infant Risk or looking it up on LactMed.
1) Dicloxacillin - LactMed: https://www.toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~7mIIna:1
2) Zantac - LactMed: https://www.toxnet.nlm.nih.gov/cgi-bin/sis/search2
3) Infant Risk: https://www.infantrisk.com
4) Evidence-based common sense? Commentary by Dr. Mark Sherman. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278294/pdf/0540166.pdf
Copyright 2019, The Lactation Pharmacist