Table 1 Summary of recommendations for safe use of human milk in the context of maternal polypharmacy.

Prefer drugs expected to achieve low concentrations in milk.

This practice will ensure minimal infant exposure to drugs through milk, as exposure is a direct function of drug concentrations in milk.

Among similar therapeutic options, prefer drug(s) with the optimal safety profile for lactation according to specialized databases, clinical specialists and PK parameters.

Application of evidence-based knowledge will allow the clinician to choose the safest treatment option for the patient from a lactation point of view, while maintaining the quality of treatment for the mother herself.

Be aware of drugs’ safety profiles and rate them from best to worst. Make a note of this in the patient’s medical chart.

Awareness of the relative safety of several drugs prescribed for the same indication will allow the clinician to perform prudent deprescribing by discontinuing the least preferred drug(s) (from a lactation point of view) first.

When safety data is insufficient, consider reducing infant exposure by alternating MOM and donor milk (preferably) or infant formula.

Alternating between MOM and other types of feed reduces drug exposure while maintaining the benefits of human milk, at least in part. This strategy may be applied in any ratio that is believed to balance the benefits and risks. Even a small amount of MOM may have an impact on the infant as well as the mother. Over time, if MOM is well-tolerated, the ratio may be shifted in favor of MOM.

As this strategy may be the most complicated to execute, its success may depend on thorough communication with the mother, shared decision-making, and adherence and compliance of the medical team.