Drugs in Lactation
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Transcript of Drugs in Lactation
DRUGSDRUGS IN IN LACTATIONLACTATION
I.I. Facts about drugs in lactationFacts about drugs in lactation
II.II. Classification of drugs in lactationClassification of drugs in lactation
III.III. Effects of drugs on the Mother & Effects of drugs on the Mother & BabyBaby
IV.IV. Measures to Minimize Effect of Measures to Minimize Effect of Maternal medicationMaternal medication
TopicsTopics
I. FACTS ABOUT DRUGS IN LACTATION
1.1. Most drugs pass through breastmilk.Most drugs pass through breastmilk.
2.2. 1% less of maternal dose appear in 1% less of maternal dose appear in breastmilk.breastmilk.
3.3. Few drugs are contraindicated.Few drugs are contraindicated.
4.4. Some drugs cause side effects on Some drugs cause side effects on the baby.the baby.
5.5. Baby’s exposure to a drug can be Baby’s exposure to a drug can be minimized.minimized.
II. Classification of Drugs for II. Classification of Drugs for BreastfeedingBreastfeeding
(As to Recommendation during (As to Recommendation during Lactation)Lactation)
ExceptionException
1. Anesthetics1. Anesthetics • SevofluraneSevoflurane• KetamineKetamine• Bupivacaine HclBupivacaine Hcl
2. Antihistaminics2. Antihistaminics • Diphenhydramine Diphenhydramine HclHcl
• LoratadineLoratadine
3. Hypnosedative3. Hypnosedative • MidazolamMidazolam• DiazepamDiazepam
I. COMPATIBLE WITH I. COMPATIBLE WITH
BREASTFEEDINGBREASTFEEDING Safe and No Contraindication Safe and No Contraindication
ExceptionException
4. Muscle 4. Muscle RelaxantRelaxant
• SuxamethoniumSuxamethonium• VecuroniumVecuronium
DantroleneDantrolene
5. Anti-5. Anti-secretory GITsecretory GIT
• CimetidineCimetidine• RanitidineRanitidine
OmeprazoleOmeprazole
MisoprostolMisoprostol
6. Analgesic 6. Analgesic
/Antipyretics/Antipyretics
• ParacetamolParacetamol• AcetaminophenAcetaminophen• NSAid (1NSAid (1stst
generation)generation)
NSAIDNSAID
22ndnd Generation Generation
CelecoxibCelecoxib
compatible
ExceptionException
7. Steroid7. Steroid • Dexamethesone Dexamethesone (single)(single)
• Hydrocortisone Hydrocortisone (single)(single)
compatible
8. Antibacterial8. Antibacterial • ErythromycinErythromycin• AmoxicillinAmoxicillin• Ampicillin Ampicillin • CloxacillinCloxacillin
9. 9. AntihypertensiveAntihypertensive
• Captopril (capoten)Captopril (capoten)• Methyldopa Methyldopa
(Aldomet)(Aldomet)
compatible
ExceptionException
10. Antidysrrhythmia10. Antidysrrhythmia • Lidocaine HclLidocaine Hcl• QuinidineQuinidine
Amioda-Amioda-ronerone
11. Cardiac 11. Cardiac GlycosideGlycoside
• DigitoxinDigitoxin• DigoxinDigoxin
12. Anti-asthma 12. Anti-asthma /Anti-oxytoxic/Anti-oxytoxic
• SalbutamolSalbutamol
13. Antitussives13. Antitussives • Codeine (single Codeine (single dosedose
• Ammonium Ammonium ChlorideChloride
compatible
compatible
ExceptionException
14. Oxytocin14. Oxytocin • Oxytocin (short Oxytocin (short term)term)
15. Diuretics15. Diuretics • MannitolMannitol• SpirinolactoneSpirinolactone
16. Dermatological16. Dermatological
AntifungalAntifungal
• Selenium SulfideSelenium Sulfide
17. Opthalmological17. Opthalmological
AntiglaucomaAntiglaucoma
• AcetazolamideAcetazolamide
18. Cytotoxic Drugs18. Cytotoxic Drugs • Calcium FolinateCalcium Folinate
compatible
ExceptionException
19. Immunologicals19. Immunologicals
ImmunoglobulineImmunoglobuline
VaccineVaccine
• Antitetanus Antitetanus ImmunoglobulineImmunoglobuline
• Diptheria Diptheria AntitoxinAntitoxin
• BCGBCG• MeaslesMeasles
• Smallpox Smallpox vaccinevaccine
20. Vitamins20. Vitamins • Ascorbic in usual Ascorbic in usual dosedose
• ThiamineThiamine
21. Antithyroid21. Antithyroid • LevothyroxineLevothyroxine
compatible
RECOMMENDATION:RECOMMENDATION:
Take the drugs and Take the drugs and
continue to breastfeedcontinue to breastfeed
II. Compatible with Breastfeeding but Monitor Infant for Side Effects
(minor side effects but rare)
Side EffectsSide Effects
1. Anti-1. Anti-cholinergiccholinergic
• AtSO4AtSO4 • Drying of Drying of secretionsecretion
• Increase Increase temperaturetemperature
2. Antiemetics2. Antiemetics • MetoclopramideMetoclopramide
3. Analgesics3. Analgesics • Pethidine in Pethidine in occasional doseoccasional dose
• Morphine in Morphine in occasional doseoccasional dose
Side EffectsSide Effects
4. Anti-TB Drugs4. Anti-TB Drugs • RifampicinRifampicin• StreptomycinStreptomycin• EthambutolEthambutol
JaundiceJaundice
5. Vitamin5. Vitamin • Ascorbic acid Ascorbic acid (large dose(large dose
HemolysisHemolysis
JaundiceJaundice
6. Antibacterial6. Antibacterial
• GentamycinGentamycin Thrush & Thrush & diarrheadiarrhea
7. Antiasthma7. Antiasthma • AminophyllineAminophylline IrritabilityIrritability
8. Antiangina8. Antiangina • VerapamilVerapamil
Compatible but monitor
Side Effects
9. Antihypertensive • Hydralazine (apresoline)
• Nifedipine
10. Diagnostic Agent
• Propyliodine Hypothyroidism
11. Anticonvulsant • Phenobarbital (luminal)
• MgSO4
• Drowsiness• Poor suckling /
weight gain
12. Analgesic /Anti-
pyretic
• ASA (occasional dose)
Compatible but monitor
RECOMMENDATIONS:RECOMMENDATIONS:
Notify mother….Notify mother….
If + side effects If + side effects stop taking the drugs stop taking the drugs and find alternativeand find alternativeIf mother cannot stop taking the drugs If mother cannot stop taking the drugs
stop stop breastfeeding breastfeeding and feed with and feed with pasteurized milkpasteurized milk
Continue milk expression Continue milk expression
III. Avoid if Possible, monitor for III. Avoid if Possible, monitor for side effectsside effects
(repeated doses (repeated doses serious side effects) serious side effects)
1. Antihistaminic1. Antihistaminic • ChlorphenamineChlorphenamine • DrowsinessDrowsiness• IrritabilityIrritability
2. Hypnosedative2. Hypnosedative • DiazepamDiazepam • DrowsinessDrowsiness
3. Opioid 3. Opioid AnalgesicAnalgesic
• Pethidine Pethidine
• MorphineMorphine
• ApneaApnea• BradycardiaBradycardia
4. Antibiotics4. Antibiotics • TetracyclineTetracycline
• ChlorampenicolChlorampenicol
• Teeth Teeth stainingstaining
• HemolysisHemolysis• JaundiceJaundice
5. Disinfectant5. Disinfectant • Povidone Povidone Iodine Iodine (Topical)(Topical)
• HypothyroidismHypothyroidism
6. Anti-angina6. Anti-angina/ / AntihypertensiveAntihypertensive
• AtenololAtenolol • BradycardiaBradycardia• HypotensionHypotension• CyanosisCyanosis
7. 7. PsychotherapeuticPsychotherapeutic
• ChlorpromazineChlorpromazine
• LithiumLithium
• DrowsinessDrowsiness• Restlessness Restlessness • WeaknessWeakness• Poor muscle Poor muscle
tonetone
8. Antibacterial8. Antibacterial • MetronidazoleMetronidazole
Avoid if possible
9.9. Antitussives Antitussives • Codeine in Codeine in repeated dosesrepeated doses
• ApneaApnea• BradycardiaBradycardia• CyanosisCyanosis
10. Ethanol10. Ethanol
IntakeIntake
• Chronic use of Chronic use of alcohol alcohol
• DrowsinessDrowsiness• Poor growthPoor growth• WeaknessWeakness
11. Caffeine11. Caffeine • Excessive Excessive dosagedosage
• WakefulnessWakefulness• HyperactivityHyperactivity• Poor sleeping Poor sleeping
patternpattern• Irritability Irritability
Avoid if possible
RECOMMENDATIONS:RECOMMENDATIONS:
• Use when essential for mother’s Rx and no safer alternative
• Continue breastfeeding and observe the baby for any changes
• Follow up + side effects stop the drugs
If not possible to stop the drugs stop BF and use pasteurized milk.
• Milk expression
IV. Avoid if Possible (May Inhibit Lactation)
1. Anti-cholinergic1. Anti-cholinergic • AtSO4 (repeated dosesAtSO4 (repeated doses
2. Anti-gout2. Anti-gout • ColchicineColchicine
3. Diuretics3. Diuretics • FurosemideFurosemide• Hydrochlorothia-zideHydrochlorothia-zide
4. Oxytocin4. Oxytocin • Ergometrine Ergometrine (repeated doses)(repeated doses)
• Oxytocin (prolonged use)Oxytocin (prolonged use)
5. Hormonal Con-5. Hormonal Con-traceptivestraceptives
• EthinylestradiolEthinylestradiol• LevonorgestrilLevonorgestril• Ethinyl estradiolEthinyl estradiol
+ Norethisterone+ Norethisterone
6. Anti-parkinsonism6. Anti-parkinsonism • CarbidopaCarbidopa• LevodopaLevodopa
7. Excess Nicotine Intake7. Excess Nicotine Intake • Cigarettes more than Cigarettes more than 20/day20/day
8. Anti-migraine8. Anti-migraine • Ergot alkaloidErgot alkaloid• Ergot ergotamineErgot ergotamine
(May Inhibit Lactation)
RECOMMENDATION:RECOMMENDATION:
Frequent Suckling Frequent Suckling of the Breastof the Breast
V. Avoid V. Avoid (Dangerous Side Effects on (Dangerous Side Effects on the Baby)the Baby)
1. Anti-neoplastic
• Cytotoxic– Cisplatin– Vincristine– Methotrexate
• Immunosuppresive– Ciclosporin– Azathioprine
2. Radiopharmaceutical Anti-2. Radiopharmaceutical Anti-thyroidthyroid
- iodine 131 or Na iodide - iodine 131 or Na iodide
(Na 131)(Na 131)
Elimination of Radio-iodine from Elimination of Radio-iodine from the milkthe milk
Na 131 - 14 daysNa 131 - 14 days
Iodine 123 - 36 hoursIodine 123 - 36 hours
125 - 12 days125 - 12 days
Cause Cause damage to damage to nursing infant nursing infant thyroidthyroid
Increase risk Increase risk of thyroid CAof thyroid CA
AVOID
3. Hallucinogenic
• Marijuana• LSD• PCP (Phen-
cyclidine)
• Irritability• Poor feeding
4. Anorexant / Appetite, suppresant
• Phentermine• Amphetamine
• CNS stimulation
may occur in nursing infant
5. Anti-lipemic • Simvastatin• Fluvastatin
AVOID
RECOMMENDATION:RECOMMENDATION:
Stop breastfeeding untilStop breastfeeding until
treatment is completedtreatment is completed
Is there a drug that is Is there a drug that is absolutely safe?absolutely safe?
EFFECTS OF DRUGS TO THE MOTHEREFFECTS OF DRUGS TO THE MOTHER
1. Estrogen /Thiazide1. Estrogen /Thiazide • Suppress lactationSuppress lactation
2. Rifampicin (Orange)2. Rifampicin (Orange) • Colors breastmilkColors breastmilk
3. Metronidazole 3. Metronidazole
IothalamateIothalamate
Flavors breast milkFlavors breast milk• (Bitter taste) Onion, (Bitter taste) Onion,
GarlicGarlic• (Radiographic Contrast (Radiographic Contrast
Media) metalic tasteMedia) metalic taste
4. Metoclopramide4. Metoclopramide • Increase lactationIncrease lactation
5. Nicotine5. Nicotine • Decrease milk productionDecrease milk production
1. Diazepam
/ Phenobarbital
• Lethargy• Drowsiness• Sedation
2. Chlorphenamine
/ Theophylline
• Irritability
3. Indomethacin • Convulsion
4. Phenobarbital
/ Carbamazepine
• Poor suckling• Poor weight gain
EFFECTS OF DRUGS TO THE BABYEFFECTS OF DRUGS TO THE BABY
5. Clindamycin5. Clindamycin • Bloody Bloody DiarrheaDiarrhea
6. Gentamycin
/ Streptomycin
• Diarrhea Diarrhea /Thrush/Thrush
7. AtSO4 • FeverFever• Drying of Drying of
secretionsecretion
8. Penicillin • RashesRashes
9. Anti-TB
/Ascorbic Acid (large doses)
/ Chloramphenicol
• JaundiceJaundice
EFFECTS OF DRUGS TO THE BABYEFFECTS OF DRUGS TO THE BABY
10. Lithium10. Lithium • Restlessness• Weakness• Poor muscle tone
11. Propranolol • Hypoglycemia• Cyanosis
12. Nicotine
(chewing gum)
• Vomiting• Tachycardia• Restlessness
13. ASA • Hemolysis• Prolonged bleeding time
EFFECTS OF DRUGS TO THE BABYEFFECTS OF DRUGS TO THE BABY
14. K Iodide14. K Iodide
/ Povidone / Povidone IodineIodine
• HypothyroidismHypothyroidism
15. Caffeine15. Caffeine • HyperactivityHyperactivity• WakefulnessWakefulness• Slow excretionSlow excretion• Poor sleeping patternPoor sleeping pattern
16. Tetracycline16. Tetracycline • Staining teethStaining teeth
17. Morphine17. Morphine
/ Pethidine/ Pethidine
• ApneaApnea• BradycardiaBradycardia
18. Morphine18. Morphine • Urinary RetentionUrinary Retention
EFFECTS OF DRUGS TO THE BABYEFFECTS OF DRUGS TO THE BABY
MEASURES TO MINIMIZE EFFECT OF MEASURES TO MINIMIZE EFFECT OF MATERNAL MEDICATIONMATERNAL MEDICATION
• Avoid long acting forms of drug.Avoid long acting forms of drug.
• Schedule the doseSchedule the dose
• Choose the safest drugChoose the safest drug
• Watch out for signs and Watch out for signs and symptoms symptoms
• If a drug may present a risk to the If a drug may present a risk to the infant measure blood infant measure blood
concentrations.concentrations.
Medicines in LactationMedicines in Lactation
judgementjudgement1. Requirement1. Requirement
careful careful assessment assessment of Risk of Risk of not givingof not giving
vs. Harmvs. Harm
indicationindication2. Usage
proven benefitsproven benefits
Salamat Po !Salamat Po !