Breastfeeding and maternal medication use

Balancing the Use of Medications While Maintaining Breastfeeding

Breast milk is the most beneficial nutrition a mother can give her infant. Fortunately, the dose of most drugs transferred into milk is small and does not lead to clinically significant effects on the infant. In almost all instances, the mother should be advised to continue breastfeeding. Certain medications are absolutely contraindicated, including anticancer agents, radioactive drugs, and those that inhibit milk production. However, most medications can be used safely. An improved understanding of the relationship between maternal and infant exposure to medications would provide a more enlightened understanding of the risk and benefit analysis for individual drugs.

Simultaneous enantioselective quantification of fluoxetine and norfluoxetine in human milk by direct sample injection using 2-dimensional liquid chromatography-tandem mass spectrometry

A two-dimensional liquid chromatography system coupled to triple quadrupole tandem mass spectrometer (2D LC-MS/MS) was employed for the simultaneously quantification of fluoxetine (FLX) and norfluoxetine (NFLX) enantiomers in human milk by direct injection of samples. A restricted access media of bovine serum albumin octadecyl column (RAM-BSAC18) was used in the first dimension for the milk proteins depletion, while an antibiotic-based chiral column was used in the second dimension. The results herein described show good selectivity, extraction efficiency, accuracy, and precision with limits of quantification in the order of 7.5ngmL(-1)for the FLX enantiomers and 10.0ngmL(-1) for NFLX enantiomers. Furthermore, it represents a practical tool in terms of sustainability for the sample preparation of such a difficult matrix.

Antibiotics and Breastfeeding

During the breastfeeding period, bacterial infections can occur in the nursing mother, requiring the use of antibiotics. A lack of accurate information may lead health care professionals and mothers to suspend breastfeeding, which may be unnecessary. This article provides information on the main antibiotics that are appropriate for clinical use and the interference of these antibiotics with the infant to support medical decisions regarding the discontinuation of breastfeeding. We aim to provide information on the pharmacokinetic factors that interfere with the passage of antibiotics into breast milk and the toxicological implications of absorption by the infant. Publications related to the 20 most frequently employed antibiotics and their transfer into breast milk were evaluated. The results demonstrate that most antibiotics in clinical use are considered suitable during breastfeeding; however, the pharmacokinetic profile of each drug must be observed to ensure the resolution of the maternal infection and the safety of the infant.

Performing elective surgery on the breastfeeding patient: a review of the literature

The prevalence of breastfeeding among women in the United States is increasing along with the understanding of the importance of continually and exclusively breastfeeding an infant in the first half year of life. Modern necessities and problems evoke questions about what medications can be safely utilized by a breastfeeding mother and which procedures she may safely undergo. Planning elective surgery for a patient who is breastfeeding is a challenge because of insufficient studies regarding medication safety, apprehension among patients, and inadequate information from care providers. Nonetheless, information on the pharmacokinetics of drugs in the maternal system, the possible adverse effects to the infant, and how to minimize drug exposure to the infant is easily accessible to both patients and their surgeons. Positively informed providers and breastfeeding mothers who elect to undergo surgery, willing to take the proper steps and precautions, ensure healthy outcomes postoperatively.

Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding?

An increasing number of women are diagnosed with cancer during pregnancy and lactation. Women are usually advised to interrupt breastfeeding during systemic anticancer treatment for fear of serious adverse effects to the nursed infant. However, the issue is poorly addressed in the literature and very few studies have evaluated the safety of breastfeeding during or after cytotoxic drugs or target agents administration. In this review we will analyze the available evidence that addresses the issue of anticancer drugs, targeted agents, antiemetics and growth-factors excretion in human milk. This could serve as a unique resource that may aid physicians in the management of breastfeeding cancer patients interested in maintaining lactation during treatment.

Lactation stage influences drug milk-to-serum values and neonatal exposure risk

The purpose of our study was to assess the influence of lactation stage-dependent differences in milk-to-serum (M/S) ratio for an actively transported drug (cefepime) on the calculation of 2 exposure indices, EI(Dose) and EI(Conc). Age-dependent differences in cefepime pharmacokinetics at postnatal days 4 and 10 as well as cefepime M/S values at lactation days 4 and 10 in rats were determined. Significantly higher elimination rate constant and systemic clearance and lower half-life were found in day 10 compared to day 4 pups with no differences in oral bioavailability. The EI(Conc) was quantitatively higher than EI(Dose) at both lactation stages. The approximately 7-fold decrease in cefepime M/S values at lactation day 10 resulted in approximately 7-fold reduction in the EI(Dose) and approximately 13-fold reduction in EI(Conc). Our study confirms the need to evaluate M/S at different lactation stages for actively transported drugs to avoid over- or underestimation of neonatal exposure risk.

Medicamentos e amamentação: atualização e revisão aplicadas à clínica materno-infantil

OBJETIVO: Realizar revisão bibliográfica sobre o uso de medicamentos durante o período de lactação. FONTES DE DADOS: Artigos nos bancos de dados eletrônicos Pubmed, Medline, Lilacs e SciELO nos últimos dez anos, nas línguas portuguesa, inglesa e espanhola, utilizando os descritores "aleitamento materno", "lactação", "leite humano" e "uso de medicamentos". Também foram consultados livros, textos recentes e artigos considerados relevantes para realização dessa revisão. SÍNTESE DOS DADOS: Os fármacos foram classificados em tabelas, conforme o risco para uso na lactação. Há carência de informações sobre a segurança de muitas medicações durante a amamentação. Dentre os fármacos com informações sobre segurança para uso na lactação, a maior parte é considerada segura e poucos são contra-indicados. Alguns merecem preocupação devido ao risco de redução da lactogênese ou produção de efeitos adversos sobre o lactente. O uso de galactagogos está restrito a situações especiais, pouco freqüentes na prática clínica. CONCLUSÕES: A freqüente necessidade do uso de medicamentos na lactação deve ser encarada com preocupação devido à conhecida relação entre o uso de fármacos e o desmame. O princípio fundamental da prescrição de medicamentos para lactantes baseia-se na avaliação dos riscos e dos benefícios. Neste momento, o conhecimento de características farmacológicas e a consulta a publicações atualizadas sobre o tema são importantes instrumentos na escolha do fármaco. Uma avaliação cuidadosa quase sempre permite compatibilizar o tratamento medicamentoso com a amamentação.

Use of anti-infective agents during lactation: Part 1--Beta-lactam antibiotics, vancomycin, quinupristin-dalfopristin, and linezolid

Because many antibiotics are excreted into the breast milk, it can be difficult for a practitioner to choose an antibiotic for a lactating patient that will have minimal risks to her nursing infant. This article is the first of a three-part series discussing the use of anti-infective agents during lactation. The authors review general information regarding use and common side effects of several classes of antibiotics. They also summarize information, including documented milk concentrations, milk-to-plasma ratios, and other pharmacokinetic properties, in a table that can help practitioners choose antibiotics that may be considered safe for the lactating mother.