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LactMed: Medical Application Critical Appraisal Assessment

  • Name: LactMed
  • Author: the Toxicology Data Network maintains LactMed.
  • Endorsement: Yes, LactMed is a part of the National Library of Medicine’sMedicine’s (NLM) Toxicology Data Network, which is operated by the United States federal government.
  • Operation: A web-based platform is more suitable for an app as it allows accessing the database. As an app was retired, and it is not designed for Android and iOS anymore, web-platform is the only solution to access a database. Moreover, a web-platform requires a user to have a reliable internet connection to access the information.
  • Aesthetics: The app is easy to navigate; however, it is less likely to be found without the instructions. It is not easy to use due to the accessibility: the app has been retired for Android and iOS, and it can only be accessed via Bookshelf. Also, the dataset can be downloaded through the Data Distribution site, which complicates the process as it cannot be downloaded from PlayMarket or Apple Store directly. However, a healthcare representative can easily find the information regarding any drug as it is located in alphabetical order, and a user can also search by the drug name or class.
  • Purpose: The app is created for healthcare professionals that can check the effects of drugs on breastfeeding infants. The information provided intends to help in clinical decision-making regarding the use of medications during breastfeeding. It can be helpful for professionals that want to discover possible adverse effects or find the most accurate drug, as the process of making a prescription may be complicated due to the individuality of each case.
  • Clinical Decision Making: The app provides information on medications to which breastfeeding mothers can be exposed. It also provides alternatives for various drugs and adverse effects, which means that it influences clinical decision making. A physician can decide what drug it would be more accurate to prescribe by relying on the information that is provided in the app. For instance, a physician may not be aware of specific adverse effects, which enables prescribing the medication he intended to prescribe.
  • Safety: There might be potential for patienpatient’s harm as the information about the drugs is updated less frequently in the app. Absence of up-to-date information can make a treatment plan less effective, which may influence a patient’s health, as an app includes details such as level of substances in breast milk and in the bloodstream of an infant. However, considering that the information in the app is updated every month, it is unlikely that changes will be crucial.
  • Privacy/Security: As an app carries informational purposes, it does not state a clear privacy policy. The information is accessible for any individuals and can be copied. However, NCBI has a disclaimer that says that information provided is not meant as a substitute for professional judgment, which means that a person cannot rely on the data without a consultation with a physician.
  • User: The app is intended for healthcare professionals, such as nurses and physicians. An app is not designed for patients as it contains specific information that requires knowledge and background in medicine to use the data appropriately.
  • Distribution: An app is designed for local distribution as it brings values to healthcare professionals only.
  • Credibility: The credibility of an app is confirmed by Krauskopf (2018), a phD who assures that all the sources are referenced. Also, a peer review panel is available that examines the information regarding scientific validity.
  • Relevance: The information is updated every month, which means that information is current. It is content with evidence-based literature as the information is provided by the National Library of Medicine, which is the world’s biggest medical library.

Prescription of medications to breastfeeding mothers can be challenging as mothers face a dilemma of using the drugs but giving up breastfeeding or discount drugs to continue breastfeeding. Hence, physicians play a crucial role in creating a treatment plan. They are supposed to convey evidence-based information on the compatibility of drugs and make a decision based on the mother-infant specific scenario. (Colaceci, Giusti, Angelis, et al., 2015).

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The patient is an American, 25 years old woman who has a previous record of depression and history of taking antidepressants and gave birth to her first child three weeks ago. She was taking prescribed medication for six months and stopped taking them once she got pregnant. However, depressive symptoms came back after the infant was born. The patient receives a consultation from a specialist in the private practice settings to decide whether she can be prescribed antidepressants and keep breastfeeding.

Before using an app, a physician should examine the patient to confirm postnatal depression. Postnatal depression has the same symptoms as regular does; however, it is more likely to appear in the first five weeks after birth due to the adjustment to the baby and the stress associated with childbirth. The previous history of depression may also become a confirmation of the accuracy of symptoms. Hence, the symptoms include low mood, lack of enjoyment in daily activities, and low energy.

However, it is important not to confuse these symptoms with healthy and common mood changes. Considering that postnatal depression can influence the relationship between the mother and infant, partner, and family, along with the history of depression in the past, the physician decides to prescribe antidepressants to prevent potentially unfavorable consequences. A doctor uses the LactMed app to prescribe appropriate medication. Firstly, he wants to gain more knowledge about the medication that was prescribed before and whether it is compatible with breastfeeding. The patient used to take Doxepin, which is a tricyclic antidepressant.

He searches for effects as the app allows searching by the drug name, and discovers that Doxepin is highly sedative, which causes similar effects to the mother as well as to the infant. (Carson, 2015). Due to the high sedative effects, he sees first-line drugs that show low levels of infant exposure and evidence of drug safety. The physician can rely on the information provided in the app as it is validated and credible. He finds that Sertraline is often recommended as the antidepressant of choice due to its low level of exposure.

Hence, an app influenced his clinical decision making and helped to select the most appropriate medication for the breastfeeding mother. Without this knowledge, a mother and infant could face unfavorable consequences that could complicate the mother’s state or negatively affect an infant.


Carson, N. (2015). Antidepressant use during breastfeeding. The Pharmaceutical Journal.

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Colaceci, S., Giusti, A., & Angelis, A. D. (2015). Medications, “Natural” Products, and Pharmacovigilance during Breastfeeding: A Mixed-Methods Study on Women’s Opinions. Journal of Human Lactation.

Krauskopf, P. B. (2018). LactMed and HEADS UP Apps. The Journal for Nurse Practicioners, 14. Web.

Appendix A

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Begin each appendix on a new page with the word “Appendix” at the top center. Use an identifying capital letter (e.g., Appendix A, Appendix B, etc.) if you have more than one appendix. If you are referring to more than one appendix in your text, use the plural appendices (APA only).

Label tables and figures in the appendix as you would in the text of your manuscript, using the letter A before the number to clarify that the table or figure belongs to the appendix.

Appendix B

Demographic Information for Cummings et al. (2002)’s Review

If an appendix consists entirely of a table or figure, the title of the table or figure should serve as the title of the appendix.

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