Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Medicine use and safety while breastfeeding: investigating the perspectives of community pharmacists in Australia

Martine de Ponti A B , Kay Stewart A , Lisa H. Amir C and Safeera Y. Hussainy A D
+ Author Affiliations
- Author Affiliations

A Centre for Medicine Use and Safety, Monash University (Parkville campus), 381 Royal Parade, Parkville, Vic. 3052, Australia.

B Utrecht University; Department of Pharmaceutical Sciences, University of Utrecht, PO Box 80082, 3508 TB, Utrecht, The Netherlands.

C Mother and Child Health Research, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.

D Corresponding author. Email: safeera.hussainy@monash.edu

Australian Journal of Primary Health 21(1) 46-57 https://doi.org/10.1071/PY13012
Submitted: 25 January 2013  Accepted: 23 June 2013   Published: 1 August 2013

Abstract

Consumers and health professionals rely on community pharmacists for accurate information about the safety of medicines. Many breastfeeding women require medications, yet we know little about the advice provided to them by pharmacists in Australia. The aim of this study therefore was to investigate the perspectives of community pharmacists in Australia on medication use and safety in breastfeeding using a postal survey of a national random sample of 1166 community pharmacies in 2011. One hundred and seventy-six pharmacists responded (51% female). Of the 52% of participants with children, many (70%) had a total breastfeeding duration (self or partner) of 27 weeks or more. The majority (92%) were confident about supplying or counselling on medication during breastfeeding. The most commonly used resources were drug company information, Australian Medicines Handbook and the Royal Women’s Pregnancy and Breastfeeding Medicine Guide. Most (80%) believed the available information to be adequate and 86% thought it accessible. Over one-third were unaware that ibuprofen and metronidazole are compatible with breastfeeding. Most (80%) were able to name at least one medicine that may decrease milk supply. We found that community pharmacists discuss medicine use in lactation and are confident of their ability to do so; however, their knowledge may be variable.


References

Akus M, Bartick M (2007) Lactation safety recommendations and reliability compared in 10 medication resources. The Annals of Pharmacotherapy 41, 1352–1360.
Lactation safety recommendations and reliability compared in 10 medication resources.Crossref | GoogleScholarGoogle Scholar | 17623757PubMed |

Amir LH, Pirotta MV (2009) Medicines for breastfeeding women: a postal survey of general practitioners in Victoria. The Medical Journal of Australia 191, 126

Amir LH, Pirotta MV (2010) Medicines for breastfeeding women: a postal survey of knowledge, attitude and practices of general practitioners in Victoria. Mother and Child Health Research, La Trobe University, Melbourne.

Amir LH, Pirotta MV, Raval M (2011) Evidence-based guidelines for use of medicines by breastfeeding women. Australian Family Physician 40, 684–690.

Anderson PO, Pochop SL, Manoguerra AS (2003) Adverse drug reactions in breastfed infants: less than imagined. Clinical Pediatrics 42, 325–340.
Adverse drug reactions in breastfed infants: less than imagined.Crossref | GoogleScholarGoogle Scholar | 12800727PubMed |

Anderson C, Blenkinsopp A, Armstrong M (2004) Feedback from community pharmacy users on the contribution of community pharmacy to improving the public’s health: a systematic review of the peer reviewed and non-peer reviewed literature 1990–2002. Health Expectations 7, 191–202.
Feedback from community pharmacy users on the contribution of community pharmacy to improving the public’s health: a systematic review of the peer reviewed and non-peer reviewed literature 1990–2002.Crossref | GoogleScholarGoogle Scholar | 15327458PubMed |

Australian Institute of Health and Welfare (2003) Pharmacy labour force to 2001. AIHW Cat. No. HWL 25. National Health Labour Force Series no. 25. Australian Institute of Health and Welfare, Canberra.

Australian Institute of Health and Welfare (2011) ‘2010 Australian national infant feeding survey: indicator results.’ (AIHW: Canberra)

Boath E, Bradley E, Henshaw C (2004) Women’s views of antidepressants in the treatment of postnatal depression. Journal of Psychosomatic Obstetrics and Gynaecology 25, 221–233.
Women’s views of antidepressants in the treatment of postnatal depression.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M%2FosFGjug%3D%3D&md5=2a6c901985ed9c11830efd4cb05edcffCAS | 15715021PubMed |

Brodribb W, Fallon A, Jackson C, Hegney D (2008) Breastfeeding and Australian GP registrars – their knowledge and attitudes. Journal of Human Lactation 24, 422–430.
Breastfeeding and Australian GP registrars – their knowledge and attitudes.Crossref | GoogleScholarGoogle Scholar | 18974291PubMed |

Buhimschi CS, Weiner CP (2009) Medications in pregnancy and lactation: Part 2. Drugs with minimal or unknown human teratogenic effect. Obstetrics and Gynecology 113, 417–432.

Eades CE, Ferguson JS, O’Carroll RE (2011) Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC Public Health 11, 582
Public health in community pharmacy: a systematic review of pharmacist and consumer views.Crossref | GoogleScholarGoogle Scholar | 21777456PubMed |

Hale TW (2004) Maternal medications during breastfeeding. Clinical Obstetrics and Gynecology 47, 696–711.
Maternal medications during breastfeeding.Crossref | GoogleScholarGoogle Scholar | 15326432PubMed |

Hughes R, Maher J, Baillie E, Shelton D (2011) Nutrition and physical activity guidance for women in the pre- and post-natal period: a continuing education needs assessment in primary health care. Australian Journal of Primary Health 17, 135–141.
Nutrition and physical activity guidance for women in the pre- and post-natal period: a continuing education needs assessment in primary health care.Crossref | GoogleScholarGoogle Scholar | 21645468PubMed |

Hussainy SY, Dermele N (2011) Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: a review. International Breastfeeding Journal 6, 11
Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: a review.Crossref | GoogleScholarGoogle Scholar | 21867562PubMed |

Ilett KF, Kristensen JH (2005) Drug use and breastfeeding. Expert Opinion on Drug Safety 4, 745–768.
Drug use and breastfeeding.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXmtVerur8%3D&md5=987807cdab34604a2eb4ce51f9c85592CAS | 16011452PubMed |

Ilett KF, Kristensen JH (2007) Analgesics and anti-inflammatory drugs. In ‘Textbook of human lactation’. (Eds TW Hale, P Hartmann) pp. 491–499. (Hale Publishing: Amarillo, TX)

Jayawickrama HS, Amir LH, Pirotta M (2010) GPs’ decision making when prescribing for breastfeeding women: content analysis of a survey. BMC Research Notes 3, 82
GPs’ decision making when prescribing for breastfeeding women: content analysis of a survey.Crossref | GoogleScholarGoogle Scholar | 20331898PubMed |

Jones W, Brown D (2003) The medication vs breastfeeding dilemma. British Journal of Midwifery 11, 550–555.

Krejcie RV, Morgan DW (1970) Determining sample size for research activities. Educational and Psychological Measurement 30, 607–610.

Kristensen JH, Ilett KF (2007) Antibiotic, antifungal, antiviral, and antiretroviral drugs. In ‘Textbook of human lactation’. (Eds TW Hale, P Hartmann) pp. 513–521. (Hale Publishing: Amarillo, TX)

Loke YC (2010) ‘Pregnancy and breastfeeding medicines guide.’ (The Royal Women’s Hospital, Pharmacy Department: Melbourne)

Madadi P, Ross CJ, Hayden MR, Carleton BC, Gaedigk A, Leeder JS, Koren G (2009) Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breastfeeding: a case-control study. Clinical Pharmacology and Therapeutics 85, 31–35.
Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breastfeeding: a case-control study.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXhsFSmt77M&md5=56abd7ec737046fa3626e3eb7393e473CAS | 18719619PubMed |

McDonald K, Amir LH, Davey M-A (2011) Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals. BMC Public Health 11, S5
Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals.Crossref | GoogleScholarGoogle Scholar | 22168473PubMed |

Merlob P, Bracha S, Kaplan B (1988) Drug use in pregnancy and breast feeding: the role of the pharmacist. International Journal of Risk & Safety in Medicine 11, 45–47.

Moretti ME, Koren G, Verjee Z, Ito S (2003) Monitoring lithium in breast milk: an individualized approach for breast-feeding mothers. Therapeutic Drug Monitoring 25, 364–366.
Monitoring lithium in breast milk: an individualized approach for breast-feeding mothers.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXktlyrsrc%3D&md5=682e57c69eded58047ab28bb7dd3d07dCAS | 12766565PubMed |

Patil AS, Kuller JA, Rhee EH (2011) Antidepressants in pregnancy: a review of commonly prescribed medications. Obstetrical & Gynecological Survey 66, 777–787.
Antidepressants in pregnancy: a review of commonly prescribed medications.Crossref | GoogleScholarGoogle Scholar |

Ronai C, Taylor JS, Dugan E, Feller E (2009) The identifying and counseling of breastfeeding women by pharmacists. Breastfeeding Medicine 4, 91–95.
The identifying and counseling of breastfeeding women by pharmacists.Crossref | GoogleScholarGoogle Scholar | 19239404PubMed |

Rossi S (2012) ‘Australian medicines handbook 2012.’ (Australian Medicines Handbook: Adelaide)

Schrempp S, Ryan-Haddad A, Gait KA (2001) Pharmacist counseling of pregnant or lactating women. Journal of the American Pharmaceutical Association 41, 887–890.

Smith F (2002) Survey research: design, sample and response. In ‘Research methods in pharmacy practice’. pp. 1–42. (Pharmaceutical Press: London)

Stultz EE, Stokes JL, Shaffer ML, Paul IM, Berlin CM (2007) Extent of medication use in breastfeeding women. Breastfeeding Medicine 2, 145–151.
Extent of medication use in breastfeeding women.Crossref | GoogleScholarGoogle Scholar | 17903100PubMed |

Turner KM, Sharp D, Folkes L, Chew-Graham C (2008) Women’s views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study. Family Practice 25, 450–455.
Women’s views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 18826994PubMed |