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There are very few drugs that can enter breast milk, so why are there so many contraindications during lactation?

There are very few drugs that can enter breast milk, so why are there so many contraindications during lactation?

Everyone thinks that there are many contraindications for breastfeeding medication, which does not mean that there are really so many contraindications in science, and many contraindications are due to social and economic reasons.

For example, if a drug wants to give a clear opinion on lactation medication on the drug instructions, it is usually necessary to provide relevant clinical trial data when approving it, but the lactating population is relatively small, the market space is not large, and the clinical trials for this group involve mothers and children, so it is difficult to obtain ethical approval and recruit test personnel, and the cost is greater and the risk is greater.

The result is that many pharmaceutical companies are reluctant to do clinical trials for lactating people.

There is no direct data without clinical trials, and the result is that there is a lack of relevant information on the drug instructions about lactation, and some have information, but it is derived from the data of other populations, not direct data, so it is written out of caution. Once there are more such drug instructions, it is easy to give everyone the impression that there are many contraindications for lactation.

before

"Over-breastfeeding"

It is also said in this article that the amount of drugs taken by mothers can enter breast milk is very small, and even less can enter the child's bloodstream at the end, so most of the drugs can be used during lactation, especially those infants and young children have direct drugs. Yihe also wrote in this article before: Don't carry it when you are sick, these medicines can be taken by breastfeeding mothers

Although it is rare, there are drugs that are contraindicated during breastfeeding. Since there are so few drugs that enter the child's body through breast milk, and the child cannot be given medicine through "over-breastfeeding", why are there still these contraindications?

This is because of the dosage at which the drug produces a therapeutic effect

and doses that can produce adverse effects

It can vary very much.

For example, penicillin, to have an anti-infective effect, may require hundreds of thousands to millions of units of dose, but to cause an allergic reaction may only need a few hundred units of dose, if we know that a child with a bacterial infection has a clear penicillin allergy, giving dozens of units of penicillin does not have a curative effect, but there is a risk of causing serious adverse reactions, so although the dose is small, it has also become a contraindication.

Another example is the toxicity of some chemotherapy drugs, if the mother is using cytotoxic chemotherapy drugs, even if a small amount of the drug enters the breast milk, and then the child eats it, although the amount is very small, it may still produce a relatively harmful toxic reaction, if the harm exceeds the benefits of breastfeeding, and the mother can not stop taking this medicine, in this case, it is better to stop breastfeeding and change to formula feeding.

This is why, although it is not possible to "over-breastfeed" to treat the disease, there may still be contraindications during lactation.

But many taboos are actually relative, for example, a few hours before the mother just finished taking the medicine, the blood concentration is relatively high, which also leads to a higher drug concentration in breast milk, and the breast milk at this time is relatively more harmful to the child, but after a few hours, the blood drug concentration drops, and the breast milk at that time is very harmful to the child, and the original taboo is no longer a taboo.

So whether it is a contraindication or not, in the final analysis, it is a trade-off, the weight on one side is the benefits of breastfeeding, and the weight on the other side is the content of the drug in breast milk, as well as the adverse effects that the drug may bring to the child, or the adverse effects of not taking the medicine to the mother. When the benefits outweigh the disadvantages, it's not a taboo, otherwise it is.

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