Rs1 - k42 - Drugs and Lactation
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Transcript of Rs1 - k42 - Drugs and Lactation
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DRUGS AND LACTATION
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Jumlah ibu menyusui makinbertambah, oleh karena itu
obat-obat yan ter!istribusike!alam ASI memba"a masalahkeba!a bayi#
Di USA bebera$a obat
!ikontrain!ikasikan bai ibuyan menyususi se$erti,amtho$trine, %imeti!ine,methima&ole, %y%lo$os$hami!e,
thioura%il !ll# 'ebanyakan obat bisa ter!a$at
!i!alam ASI, teta$i !alam(umlah yan se!ikit# Sebaba hal
ini terantun !ari ka!ar obat
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MENYUSUI ipofise Prolaktin
Jaringan mammaOxytosin ASI
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Kemampuan obat masuk kekompartemen susu
tergantung dari beberapa faktor seperti berat molekul,
kelarutan lipid,, kelarutan dalam air, pengikatan dengan
protein plasma, pKa obat.
Makin kecil berat molekulmakin banyak obat bisa masuk
kedalam ASI, sebaliknya makin besar berat molekul
makin sedikit masuk ke ASI.
Makin banyak obat terikat dengan protein plasma ibu,
makin sedikt obat yang bebas yang bisa masuk kdalam
ASI. kd
Obat masuk kedalam ASI secara difusi pasif
http://neoreviews.aappublications.org/cgi/content/full/neoreviews;5/4/e164/F2 -
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Tidak semua obat didalam darah ibu bisa masuk
kedalam ASI, hanya obat-obat yang tak terikat pada
protein plasma ibu yang dapat masuk kedalam ASI
alaupun plasma mengandung lipid tetapi tidak
sebanyak yag terdapat dlam ASI yang banyaknya !-
"!# triglyceride, sehingga obat yang telah masuk
kedalam ASI tak bisa kembali ke ibu
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Prolactin
Therapeutic Uses / Preparations:
Causesof Hyperprolactinaemia
)hysioloi%al *$renan%y + $ost-$artum oestroen-stimulate!
.y$othyroi!ism *%ausin TR. e/%ess
*0a%ro$rola%tinaemia )rola%tinoma .y$othalami% !o$amine !e1i%ien%y De1e%ti2e !o$amine !eli2ery La%totro$h %ells insensiti2ity to !o$amine Do$amine antaonists $resent
Treatmentof Hyperprolactinaemia
Corre%tion o1 un!erlyin %ause
Do$amine analoues
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Do$amine AnalouesBromocriptine
3rot $e$ti!e alkaloi!
.ihly sele%ti2e !o$amine re%e$tor aonist#
4eak -a!reneri% an! 5-.T aonist#
Inhibits Gi-$rotein %ou$le! a!enylyl %y%lase
Inhibits $rola%tin release#
Inhibits ro"th hormone release, es$e%ially in G.-se%retin tumour"hi%h %o-se%rete $rola%tin#
Dosage
on%e - three times !aily#
Sa1e in 1irst 6-"eeks o1 $renan%y
Adverse Effects
nausea *stimulation o1 me!ullary 2omitin %entre#
7asos$asm at hih !osae
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Dopamine Analogues
Cabergoline
2ery lon hal1-li1e o1 $rola%tin su$$ression allo"st"i%e-"eekly !osae#
Less ten!en%y than bromo%ri$tine to %ausenausea8 $robably better re%e$tor sele%ti2ity#
Ne"er8 less e/$erien%e in early $renan%y8 no
reason to belie2e a $roblem e/ists#
Lon-term a!2erse e11e%ts unkno"n
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Drus That Stimulatin 0ilk)ro!u%tion
Rememert!e follo"ing commonl# used drugsma#cause $#perprolactinaemia%
Dopamine antagonistAnti&nausea agents' e(g(
meto%lo$rami!e *e## 0a/olon
$ro%hlor$era&ine *Stemetil
!om$eri!one *0otilium
Neuroleptics ) Ma*or tran+uillisers' e(g(
%hlor$roma&ine
tra&o!one
$ro%hlor$era&ine
thiori!a&ine#
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Drus That Inhibit 0ilk)ro!u%tion
9romo%ri$tine
Caberoline
)eroli!e Thia&i!e !iureti%s
The %ombine! oral %ontra%e$ti2e $ill
:uinaoli!e
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Some drugs contraindicated inlactation ,reast&feeding-
9romo%ri$tine
Co%aine
Cy%lo$hos$hami!e
Cy%los$orine Do/orubi%in
Lithium
0ethotre/ate )hen%y%li!ine
)henin!ione Ra!ioa%ti2e io!ine an! other ra!iolable!
elements
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Some drugs contraindicated inlactation ,reast&feeding-
Ci$ro1lo/a%in Chloram$heni%ol Do/e$in
Gol! Cytoto/i% !rus Io!ine-%ontainin %om$oun!s *in%lu!in
to$i%al io!ine
Amio!arone An!roens Dana&ol 3rotamine
La/ati2es
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;a%tors In1luen%in the Trans1er o1Drus 1rom 0other to In1ant in 9reast
0ilk
;a%tors that a11e%t the %on%entrationo1 !ru in the mother
Dru !ose, 1re
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;a%tors that a11e%t trans1er a%rossthe breast 9reast bloo! 1lo"
0etabolism o1 !ru "ithin the breast 0ole%ular "eiht o1 the !ru
Deree o1 ioni&ation o1 the !ru
Solubility o1 the !ru in "ater an! li$i!s
Relati2e bin!in a11inity to $lasma an!milk $rotein
Di11eren%e bet"een the $. o1 maternal$lasma an! milk
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;a%tors that a11e%t !ru%on%entration in the in1ant
Timin o1 1ee!s
;re