International Board of Certified Lactation Consultant (IBCLC) Practice Exam

What is an L4 medication that should be avoided when nursing to quit smoking?

1. Nicotine patches

2. Bupropion

3. Varenicline

4. Gum therapy

The correct answer is: Varenicline

Varenicline, an L4 medication, is classified as a medication that should generally be avoided during breastfeeding due to potential risks to the infant. It is a partial agonist at the alpha-4 beta-2 nicotinic acetylcholine receptors and is used primarily to help individuals cease smoking by reducing cravings and withdrawal symptoms. The concern with this medication arises from limited data regarding its safety during lactation, along with the potential for adverse effects on the nursing infant. While nicotine patches and gum therapy deliver nicotine at lower levels and have been shown to have a more favorable safety profile for breastfeeding mothers, bupropion is classified as an L2 medication, indicating it is relatively safe. The classifications provide healthcare providers with guidelines on the use of these medications during lactation, with L4 indicating the least safety confidence. Thus, for mothers who are nursing and wish to quit smoking, varenicline is advised against due to the uncertainties surrounding its effects on breast milk and the nursing child.