Instead of just reading drug packaging inserts of the Physicians Drug Reference (PDR), which consists basically of reprinted product inserts, you should check drug references that specifically deal with the issue of breast milk and medications. One of the best, and most commonly used, is "Medications and Mothers' Milk 2000" by Dr. Thomas Hale. In addition, the American Academy of Pediatrics provides some publications that deal with the same issues.

Some important steps to take include:

• A review of the data about a drug. This might include the above references or recent literature about the issue.
• Determine if the milk-plasma ratio of drugs in question is high. Determine if the amount absorbed by the infant has been reported to produce side effects.
• When choosing medications, try to choose drugs with shorter half-lives since these enter the milk at lower levels.
• Be cautious of medications with active metabolites. Often these metabolites have longer half-lives or have not been adequately studied.
• Choose medications that have higher protein binding because these are usually bound on the maternal circulation side and are not easily transferred to milk.
• Determine the side-effects (if any) that might be possible in the infant and inform the mother (and yourself) about these.

Again, an open and honest discussion about patient desires and goals coupled with information about options, risks, benefits and possibilities will make for the best possible situation and the most healthy outcome for both mother and child.