12/3/2023 0 Comments Norco while breastfeedingMedications and Mothers' Milk: A Manual of Lactational Pharmacology by Thomas W. (Most antidepressants are lipophilic, while most antibiotics are lipophobic.) Finding reliable sources of informationĪs you search for information on drug/breast milk interactions, three sources are worth consideration. High lipophilicity favors drug accumulation in milk. Lipid-soluble drugs diffuse more readily through lipid-filled membranes. For lactating women, lower oral bioavailability is preferable, because the drug will be poorly absorbed from both the mother's and the baby's gut. Insulin is completely unavailable orally. The oral bioavailability of gentamycin is less than 1%, meaning that less than 1% of an oral dose of gentamycin reaches the maternal plasma after being taken by mouth. Drugs with low oral bioavailability may be inactivated by gastric acid or poorly absorbed through the gastrointestinal tract. A milk/plasma ratio of less than 1 is preferred. A ratio less than 1 suggests that only small amounts of the drug are transferred into the milk. A ratio greater than 1 indicates that the drug achieves higher concentrations in the breast milk than in the blood. The milk/ plasma ratio reflects the concentration of a drug in the mother's milk divided by the concentration in her blood. For antidepressants, paroxetine (half-life 21 hours), is a better choice than fluoxetine (half-life of 2≣ days). So for example, among anti-inflammatories, ibuprofen (half-life 1.8≢.5 hours) is a better choice than naproxen (half-life 12≡5 hours). A woman on a medication with a half-life of 2 hours can take her medication immediately after breastfeeding, and most of the drug will have cleared her system by the next feeding. For lactating women, drugs with a short half-life are preferred. TABLE 1 Which drugs are OK for mothers to take while breastfeeding? Factors to be considered when assessing the safety of drugs taken by lactating women include passive diffusion, molecular weight (MW), plasma protein binding, half-life, milk/plasma ratio, oral bioavailability, volume of distribution, ionization characteristics, and lipid solubility (Table 1). To gain access into breast milk, a drug in the maternal circulation must first cross the capillary endothelium, enter into the mammary alveolar cell and then be secreted into the lumen of the alveolus. The principles of pharmacokinetics govern drug transfer across membranes into breast milk as well as drug metabolism in the mother and nursing infant. Our goal here is to help busy clinicians understand this often confusing area of health care. Weaning, even temporarily, is traumatic for both mother and baby. Women are often advised against breastfeeding even when the medication of concern is actually approved for use in infants. Mothers should balance short-term concerns over medication with the longer-term health risks of formula feeding. A baby may not accept "temporary weaning." In fact, he or she may stop feeding altogether. In our experience, clinicians and many of the resources they turn toare too cautious when providing advice on breastfeeding and medications. 2,3 One report suggests that half of all mothers are more reluctant to take medication while nursing than during their pregnancy. Unfortunately, all too often that concern translates into noncompliance, unnecessary weaning, or complete avoidance of breastfeeding. 1 It should come as no surprise to discover that many of these women worry about whether these drugs will harm their nursing infant. Two experts in this area provide an informed, balanced perspective.Ībout nine out of every 10 breastfeeding women are prescribed some type of medication during their first week postpartum. Is it possible to be too cautious about prescribing medication to a breastfeeding patient? Absolutely. Which medication to choose? Finding reliable sources of information Answering common questions about common drugs Take-home messages By Barbara L.
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