LactMed database offered free to pharmacists, physicians, and others
All info on lactation and drug impact included
If a peer-reviewed study is published with outcomes involving lactating women and the impact of medications on their infants, then it is included in the LactMed database, sponsored by the National Institutes of Health's National Library of Medicine.
Physicians, pharmacists, and new mothers can search the database for information about how medications lactating women take might impact their infants. With the recent resurgence in breastfeeding, the information is particularly valuable.
However, it would be difficult to find literature about any particular drug's impact on breastfeeding infants through the usual medication databases. So one pharmacist and professor created a database for this very purpose.
"I proposed the database to the National Library of Medicine about six or seven years ago," says Philip Anderson, PharmD, FASHP, health sciences clinical professor of pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California-San Diego.
"They decided to go ahead with it, and we designated a review panel and all met together to come up with a format for the database and how to handle information in the literature," Anderson says.
"We had an international group of physicians and pharmacists who we let see a mock-up version of the database," he says.
The experts recommended that the database put a quick summary at the beginning of each medication listing, he notes.
"So the first paragraph has the summary of all the information and a more detailed record," Anderson says.
Anderson keeps the database up-to-date.
"Since then I've been producing almost all of the records in the database, and they go out for expert peer review," he says.
Anderson, who has been involved with this kind of work for 35 years, became concerned at least a couple of decades ago about the lack of free information on drugs and breastfeeding.
"Much of what is available in drug databases comes from the package insert, which is a very poor source of information," Anderson says. "The FDA has recognized this and has proposed new labeling for drugs and breastfeeding for the package inserts, but it hasn't been approved yet, much less implemented."
It likely will be many years before that information is available, Anderson says.
So the LactMed database, with more than 700 drugs listed, is the chief resource clinicians should access if they have any questions regarding a particular drug and the impact on breastfeeding infants.
Anderson has a contract with the National Library of Medicine to keep the database updated, and he checks weekly for new information to add.
"I have e-mails sent to me from several major databases, and when new information comes out, it's added within a month," he says.
The LactMed database, located on-line at http://toxnet.nlm.nih.gov/, is part of the ToxNet family of databases.
"All information on the database is supported by a review of literature," Anderson says. "It includes how much of the medication is found in milk, how much in breastfeeding infants, what effects have been reported in breastfed infants, and what effects, if any, does the drug have on lactation itself."
The LactMed database is the third most-visited database of the ToxNet databases, Anderson notes. (See sample drug listing in LactMed database.)
"The other ones have been around quite a long time, and mine is the newest one," he adds. "That goes to the need for this kind of information."
The database is written to be viewed by physicians, pharmacists, and other health care professionals, although it's frequently accessed by the public, as well, he says.
"Nurses and people in the breastfeeding community have made this a site of choice for information," Anderson says.
"What we find sometimes is that when physicians are unclear about the safety of a drug in breastfeeding, they'll often just tell the mothers to stop breastfeeding and usually that's not really necessary," he explains. "So mothers often times will print out this information from the database and take it to their doctors to show to them."
Hospital pharmacists could access the database when concerned about an inpatient who has been breastfeeding and now needs a new medication.
"There might be issues about whether they should breastfeed or continue using breast milk," Anderson says. "They can check LactMed whenever the situation comes up."
For instance, a new mother who is admitted for postpartum infection could be prescribed an antibiotic that will not adversely impact her breastfeeding infant.
Some medications, such as antidepressants, have been more heavily researched in lactating women than have others.
Based on comments Anderson has reviewed from people accessing the web site, there are common concerns about the lack of information on a particular drug.
When Anderson sees these questions, he'll include the drug's name with the comment that there is no information about it, and the database will refer users to similar drugs that could be used in place of the one they've looked up.
"So if a drug they look up is either unacceptable because of toxicity or lack of information on it, then the user will be referred to a link with a substitute," Anderson says.
"The references are meant to be comprehensive," he adds. "If anything is known, it's put in the database."
Also, all references have a hotlink directly to Pubmed, the database for published scientific studies and reports.
"If it's a blue number, it pops open to Pubmed, and you can see the abstract of the article or go to the full text if you have access to it," Anderson says.
If a peer-reviewed study is published with outcomes involving lactating women and the impact of medications on their infants, then it is included in the LactMed database, sponsored by the National Institutes of Health's National Library of Medicine.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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