Booby Traps Series: Dispensing bad advice at the pharmacy counter

This post is the 59th in a series of posts on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

You may know that nursing moms often get poor advice from providers about medications, but did you know that the professionals responsible for knowing all about medications, and dispensing them, may pose a Booby Trap, too?

A 2007 study of two large retail pharmacy chain databases on the East Coast sought to determine the “reliability of safety recommendations for drugs used during lactation, based on current research and information, and determine whether resources may be inappropriately advising the interruption of breast-feeding.”  They examined the sources of information used, and the recommendations for use of, 14 commonly prescribed medications.

The findings:

Pharmacists were using outdated sources for making safety recommendations to their breastfeeding patients, a practice which “may result in many women being inappropriately advised to stop breast-feeding.”

For eight drugs considered unequivocally safe, the 2 retail pharmacy databases inappropriately advised mothers to stop nursing at least 75% of the time.

“Recommendations from the retail pharmacies mostly do not reflect…any current resource.”

For example, let’s look what the authors found when they reviewed the recommendations about the drug Pantoprazole, a gastric reflux medication.  Dr. Thomas Hale’s Medications and Mother’s Milk rated the risk at the lowest: “L1- safest.”  LactMed, the online database run by the National Institutes of Health rated it “no risk expected.”  These ratings were based on “a published source of human data from 2004 showing that the drug passes minimally into breast milk.”

The databases commonly used by pharmacists rated it “infant risk cannot be ruled out,” “safety unknown,” “check with physician or pharmacist; unknown whether it enters milk,” and “absolute contraindication.”  Think a few mothers have been told to stop breastfeeding to take this drug?

Dr. Melissa Bartick, co-author of the study, explained a common mindset among pharmacists when confronted with a nursing mother:

“Often pharmacists and clinicians mistakenly think that if one doesn’t know the safety information for a drug, it is safest to advise the patient to stop breastfeeding. Clinicians and pharmacists need to appreciate that such advice may carry serious health risks, too, often much worse than the risk of taking a drug.”

The authors’ conclusion:  “We should replace the assumption ‘when in doubt, don’t breast-feed’ with the mandate “when in doubt, look it up in a reliable source.”

This study was completed before Dr. Thomas Hale and Texas Tech University established the Infant Risk Center, a free, current, evidence-based service available to both moms and health care providers like pharmacists, though the free online LactMed database and Dr. Hale’s indispensable Medications and Mother’s Milk should have been at their fingertips.

Between the Infant Risk Center, LactMed, an app version of Dr. Hale’s Medications and Mother’s Milk, there really is no excuse for dispensing poor information at the pharmacy counter.

Have you received bad information at the pharmacy counter?  Were you told that a medication was unsafe when it wasn’t, or safe when it was unsafe? 

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