Jahnsen Jan Anker, Widnes Sofia Frost, Schjøtt Jan
Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.
Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
Int Breastfeed J. 2018 Jan 9;13:1. doi: 10.1186/s13006-017-0143-8. eCollection 2018.
Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice.
A random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with "BREASTFEEDING" in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used.
In the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly ( < 0.05) more likely when the enquirer was a physician.
This analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug.
由于药品说明书中的限制建议，卫生专业人员可能会建议女性停止母乳喂养或停止药物治疗。挪威的区域药品信息和药物警戒中心（RELIS）在一个全文可搜索的数据库（RELIS数据库）中，提供关于药物和母乳喂养问题的免费且独立于行业的答案。我们使用RELIS数据库来描述哪些医疗保健从业者寻求有关哺乳期用药安全性的信息、涉及的最常见药物、提供的建议以及用于提供建议的资源。
对2011年1月至2015年12月期间RELIS数据库中索引为“母乳喂养”的100对问答（QAP）进行随机抽样分析。纳入标准是卫生专业人员关于药物的询问。关于草药补充剂和其他未归类为药物的暴露的问题被排除。对QAP进行人工分析，以确定一种或几种药物与母乳喂养的兼容性、询问者的医疗保健专业和工作场所，以及所使用的建议和搜索策略。
在100对QAP中，涉及152种药物的询问。74个问题涉及单一药物，但评估的药物数量在1至16种之间。59个问题来自医生，34个来自护士或助产士，2个来自药剂师，2个来自其他卫生专业人员。医生的问题包含93次药物评估（61%），护士或助产士的问题包含47次（31%），药剂师的问题包含7次（5%）。最常见的药物类别是抗抑郁药、抗癫痫药和免疫抑制剂。询问最多的药物是拉莫三嗪、可待因、喹硫平和艾司西酞普兰。59%的药物在母乳喂养时被认为是安全的，16%的药物在采取预防措施时是安全的，12%的药物不建议使用。39%的药物评估使用了高级文献搜索策略，当询问者是医生时，这种情况的可能性显著更高（<0.05）。
对挪威药品信息中心关于母乳喂养用药问题的分析表明，需要就影响神经系统的药物安全性进行沟通，主要是与医生和助产士沟通。在大多数情况下，药品信息中心可以让人们放心在服用药物时母乳喂养的安全性。
