I don't know who to listen to - ped, LC, LLL - concerning bf and drug interaction

[LucyG]

I will most likely have to start taking a thyroid medication called propylthiouracil. I have consulted with my family doctor, a ped, a LC, a LLL leader, and Dr. Sears' Baby Book. All but the ped say that taking the drug while nursing is safe. It is a "green light" drug, according to Dr. Sears. The ped said he advised against it, and that if I do decide to continue nursing while I'm on the medicine, I'll need to bring the baby in to have her thyroid level tested monthly. The drug is suppresses the production of the thyroid hormone, and I may have to be on it long-term. I am SO confused, and more and more depressed by the minute. I want so much to continue nursing (DD is 5 months), but I don't want to hurt her by doing so. How do you know who to listen to in cases like this?

[josephsmom]

I feel for you; you're faced with a hard decision. You might want to check the patient information that comes with the medicine, and/or read up on it in the Physicians' Desk Reference (PDR) at the library, and/or consult with your pharmacist. IMHO, if you continue to get conflicting information, go with your ped's advice.

Helene
mommy to Joseph 12/29/01

[Rachels]

I've been looking this up for you. Propylthiouracil is approved by the AAP for use while breastfeeding. I haven't found ANY sources saying you shouldn't nurse while taking it. I also haven't found any sources saying that your baby has to have her thyroid levels tested while you're taking this medication. Your ped is in the minority on this one for a reason. I'd take the medication and keep nursing, if it were me, and I wouldn't subject my child to monthly bloodtests. If your ped fights you on this, think about finding a new one. You do NOT have to choose between protecting your health and nursing your baby.

-Rachel
Mom to Abigail Rose
5/18/02

[millerpjm]

Another type of doctor you could check with is an endocrinologist - they are specialists with regards to the thyroid diseases and diabetes. I would take the ped.'s advice over that of an LC or LLL leader, since a dr. knows more about actual medicines, but it's a toss up for me as to whether to listen to the ped or the family dr. I always prefer to err on the side of caution. You could also check with the pharmacist regarding the effects of the particular drug.

Hope this helps!

Jen

Proud mama to Thomas 2/3/03

[LucyG]

Jen,

Thanks for your suggestion. I just requested a referral to an endocrinologist. She has a great reputation in our area. I think I'll feel better after seeing her, since this is her area of expertise.

[JerseyMom]

You have 4 respected resources, but you are letting one doctor make you crazy. The doctor is being very, very conservative, and at the detriment to your health.

The pedatrician's interest is your son's health, not yours. His 2nd interest is his malpractice insurance. I can understand why he would hesitate letting you take anything that may or may not affect the child under his care. He means well, but considering how many other resources have told you that taking this medication is fine folr you AND your baby, well, I would put my trust into the majority.

I recently had a stomach flu and really needed to take some medication. My pediatrician would not recommend any over the counter meds, when I know for certain there are quite a few options that would have alleviated my symptoms. My internist and my LC recommended a few drugs which I took and I started feeling so much better, which of course made me able to better take care of my son. It is a shame the pediatrician couldn't look past their own needs to consider my son's welfare and not just his health.

Your son will be fine. Really. Have faith and take care of yourself.

[COElizabeth]

Personally, if the drug were on the AAP list of drugs considered compatible with BFing, I would take it and continue nursing. You might ask your ped why he advises against it when the AAP has okayed it. In my experience, peds get very uncomfortable bucking the "party line" of the AAP! Also, I think doctors often think there is no tradeoff in risk, so it's easy to recommend stopping nursing, but there is risk with that, too, because breastfeeding is associated with fewer health problems in other areas (fewer ear infections, for one, but there are a lot of them). I know it''s a tough thing to think that you could possibly be exposing your child to any danger, but knowing there are risks with any feeding choice makes me feel more confident in breastfeeding. There are many drugs where it would be a tougher call, but it sounds to me like this shouldn't be too hard a choice if it really is on the AAP compatible list. I hope things work out well!

Elizabeth
Mom to James
9-20-02

[COElizabeth]

Just wanted to add that I found a note on Dr. Hale's website (he is a pharmacologist who specializes in medications and breastfeeding - my hospital's lactation program was the one who told me about him). He was answering a question about another antithyroid drug. He said this drug was fine but that he would have the baby's blood tested the first month to be cautious. You could always choose to do one thyroid function test just to make sure things are okay.

Also, if you can get a copy of Dr. Hale's book, Medications and Mothers' Milk, you could probably find info on the half-life of the drug and other information that might help you. For example, if it has a short half-life, you can really minimize the amount your baby gets by taking the drug right after nursing before bed and then not nursing again for a few hours. But that is all just extra precaution. As I said, if it's on the AAP compatible list, I probably wouldn't worry too much about timing of the med.

Elizabeth
Mom to James
9-20-02

[chrissyhowie]

I definitely understand your confusion. It is very frustrating to get conflicting answers, especially when it concerns our children.

I know you trust your pediatrician, and you have to choose whatever your best instincts tell you to do, but I did want to make you aware that there is a large body of medical literature that states that propylthiouracil (PTU) is safe to take while breast feeding. For many years women who took hyperthyroid meds were prohibited from breast feeding, but research from as early as the late 1970s proved that PTU is safe. Yes, it is found in breastmilk, but in neglible amounts that have been found to be safe for infants. Here's a link to an article:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6103158&dopt=Abstract

I know it is an older article, but I think the title, "Propylthiouracil in human milk. Revision of a dogma" reflects very well that the older thinking that breast feeding should be stopped was incorrect. I myself have not seen any medical literature that states PTU is not safe for breast feeding.

For future pregnancies PTU may have more effect on suppressing fetal thyroid function if taken while pregnant. The newborn infant should be checked, but those effects usually spontaneously reverse once the baby is born and is no longer getting the medication in the doses it once was through your placenta. It is actually more dangerous for the pregnancy to have uncontrolled thyroid function.

Again, you have to go with your gut. But please know that the medical literature is filled with research that states that it is okay to breastfeed while taking PTU.

[Rachels]

...and remember that the ped and endocinologist are not necessarily specialists in breastfeeding. They may know lots about meds and little if anything about transmission through breastmilk. Not all meds are created equal in this respect, and neither are all doctors. I'd trust the AAP recommedation over a single opinion in this case.

Also, here's another nod to Hale's book! My ped carries it around with her.

-Rachel
Mom to Abigail Rose
5/18/02

[flagger]

I think your ped does have a point and is right on about wanting to check on your baby's thyroid levels. He also may want to avoid any issues of malpractice.

http://www.nursespdr.com/members/database/ndrhtml/propylthiouracil.html

Contraindications: Lactation--may cause hypothyroidism in infant.

Note the may in that statement.

There was another question from someone with hyperthyroidism and chrissyhowe did respond that the benefits for you outweigh the temporary possible hypothroidism in your infant (at least while your are BFng).