Table 4 List of resources, type and utility (in alphabetical order) on medication safety in breastfeeding that have been previously investigated by Akus and Bartick [16]
Name of resource | Type of resource | Utility of resource |
|---|---|---|
American Academy of Pediatrics (AAP) list | Online http://pediatrics.aappublications.org/content/108/3/776.full.html | This list is reviewed by an expert panel who applies a descriptive rating system. Possible effects of agents (medicines and other treatments or products e.g. silicone implants, nicotine) on the infant or on lactation are described in tabular format. The intention is to help physicians with counselling a nursing mother regarding breastfeeding when the mother has a condition for which a medicine is indicated. |
Clin-eguide http://www.ovid.com/site/products/tools/ovid/ClinicalResource.jsp | Patient handout from pharmacy database | Clin-eguide is an Ovid Clinical Decision Support tool for physicians. In this study, it was used by a retail pharmacy to provide information on the use of medicines in breastfeeding in the form of patient handouts (MedFacts). |
Drugs in Pregnancy and Lactation | Book | Consists of monographs that include primary research and the AAP rating, as well as its own descriptive rating system. |
Epocrates | Web-based http://www.epocrates.com/ and handheld | Program used by pharmacists and prescribers that provides a brief recommendation for each medicine, such as 'safe' or 'unknown' without additional information. The source of the recommendation is not given. |
First DataBank | Patient handout from pharmacy database | Similar to Clin-eguide, this is a clinical decision support tool that provides access to drug databases. In this study, it was used by a retail pharmacy to provide information on the use of medicines in breastfeeding in the form of patient handouts. |
LactMed | Free online resource from the National Library of Medicine that has been assembled by an expert panel. Features drug monographs and typically includes primary research, the AAP rating, and a summary at the top of each monograph. Unlike the AAP list and Drugs in Pregnancy and Lactation, it does not have a descriptive rating system. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate medicines to consider. | |
Lexi-Comp | Web-based http://www.lexi.com/ and handheld | Program used by pharmacists and prescribers (e.g. physicians, advanced practice nurses, dentists) that gives brief recommendations on lactation and breastfeeding considerations which are sometimes not consistent with each other. It often cites the AAP list but does not typically elaborate on its conclusions otherwise. |
Medication and Mothers Milk | Book | Written by a clinical pharmacologist (Hale, Thomas) and updated biannually, this book features monographs on a large range of medicines (e.g. vitamins, herbs, vaccines) and environmental substances (e.g. radioisotopes, radiocontrast agents). Relevant pharmacological characteristics, primary research, and the AAP ratings are included in the monographs. Rather than a descriptive rating system, it applies a 5 point numerical rating system to each medicine, where L1 is safest and L5 is contraindicated. |
Micromedex | Online http://www.micromedex.com/ and handheld | Used by pharmacists and other clinicians and similar to Clin e-guide and First Databank, this is a clinical decision support tool that consists of monographs that include primary research and the AAP rating. It also features its own descriptive rating system. |
Physician's Desk Reference http://www.pdr.net/ | Pharmacy database | Like Clin e-guide and First Databank, this program can be used to generate package inserts or patient handouts on the use of medicines in breastfeeding. It gives little information on how its recommendations were reached. |