Bejegyzés

Breastfeeding and antiinfectious agents

Hernádez MT, Paricio JM, Pemán J, Sánchez M, Beseler B, Benlloch MJ.
Rev Esp Quimioter. 2009 Dec;22(4):180-189.

Abstract

Not infrequently an infection or an antibiotic treatment needed by a lactating mother leads to medical advice against breastfeeding. However, advising against breastfeeding increases morbi-mortality risk in the infant. Besides there are few anti-infectious agents not compatible with breastfeeding, and in these cases, there is usually an alternative to treat the mother’s illness.

Thus it is important for health professionals to be informed of best sources where to look for the best treatment for the mother compatible with breastfeeding. This article offers the reader a review of basic pharmacodynamics which influence drug use in human lactation, an alphabetically ordered list of available anti-infectious agents coded by numbers indicating risk level, and some web recommendations for the interested reader.
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Antithyroid drugs used in the treatment of hyperthyroidism during breast feeding. An update and new perspectives

Commentary

Spyros Karras, Themistoklis Tzotzas, Gerasimos E. Krassas
HORMONES 2009, 8(4):254-257

Antithyroid drugs (ATD) are widely used by endocrinologists all over the world for the treatment of Graves’ disease (GD) in the general population and in lactating thyrotoxic mothers. Traditionally, these agents produce minor side effects (rash, fever, urticaria) in 5-10% of the treated patients and major side effects (agranulocytosis, vasculitis, hepatic toxicity) much less frequently. These side effects appear more likely to be dose-related for methimazole (MMI) rather than propylthiouracil (PTU).

To our knowledge, there are no specific data regarding the occurrence of minor side effects that might occur in lactating thyrotoxic mothers under ATD.
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Pharmacologic treatment of hyperthyroidism during lactation

Miguel Marcelo Glatstein, Facundo Garcia-Bournissen, Norberto Giglio, Yaron Finkelstein, and Gideon Koren
Can Fam Physician Vol. 55, No. 8, August 2009, pp.797 – 798

QUESTION I have a patient who has hyperthyroidism due to Graves disease. She was taking methimazole but discontinued when she found out she was pregnant. She is currently close to delivery and might require antithyroid therapy in the postpartum period. Can methimazole cross into human milk, and is breastfeeding safe for her infant?

ANSWER The exposure of infants to methimazole or propylthiouracil through breast milk is minimal and not clinically significant. Women with hyperthyroidism using methimazole or propylthiouracil should not be discouraged from breastfeeding, as the benefits of breastfeeding largely outweigh the theoretical minimal risks.
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The Identifying and Counseling of Breastfeeding Women by Pharmacists

Christina Ronai, Julie Scott Taylor, Erin Dugan and Edward Feller
BREASTFEEDING MEDICINE Volume 4, Number 2, 2009

Abstract

Objective: Concerns about medications influence breastfeeding decisions. Mothers may stop breastfeeding when they take medications. After the distribution of Thomas Hale’s Medications and Mother’s Milk (MMM) (Hale Publishing, Amarillo, TX, 2006) by the Rhode Island Department of Health (Providence, RI) in November 2006 to Rhode Island pharmacies, we investigated, during the summer of 2007, what strategies and resources pharmacists were using to identify breastfeeding women and guide medication recommendations.

Methods: Copies of MMM were sent to 47 pharmacies in Rhode Island. Subsequently, one pharmacist at each site completed a confidential, 10-question written survey.
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Breastfeeding with Postpartum Depression

Adam Slevin
Physician Assistants Vol. 15; Issue 3; Page 33

New mothers who develop postpartum depression and who want to breastfeed their infants present a treatment challenge. SSRIs may be a safe and effective option for mother and child alike.

About 10% of women who have recently given birth experience postpartum depression (PPD), making this disorder the most common complication of childbearing. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not recognize PPD as distinct from major depression, but it does provide the addition of a postpartum-onset specifier for women with an onset of depression within four weeks of delivery.
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The Safety of Macrolides During Lactation

Goldstein LH, Berlin M, Tsur L, Bortnik O, Binyamini L, Berkovitch M.
Breastfeed Med. 2009 Apr 15.

Background: Infantile exposure to macrolides has been associated with hypertrophic pyloric stenosis causing projectile vomiting, dehydration, electrolyte abnormalities, and in rare cases death possibly via macrolide interaction with gastric motilin receptors. Large population-based cohorts have suggested that exposure to macrolides via breastmilk may be associated with pyloric stenosis.

Conclusions: Rates and types of minor adverse reactions in breastfed infants exposed to a macrolide or amoxicillin in breastmilk were comparable. Macrolide exposure during breastfeeding was not associated with pyloric stenosis, although larger prospective studies are required to confirm our observation.
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Use of hypoglycemic drugs during lactation

Miguel Marcelo Glatstein, Nada Djokanovic, Facundo Garcia-Bournissen, Yaron Finkelstein, Gideon Koren
Can Fam Physician Vol. 55, No. 4, April 2009, pp.371 – 373

QUESTION My patient was taking glipizide (an oral sulfonylurea) for type 2 diabetes. Now she is pregnant and taking insulin instead. She is very anxious to return to her previous treatment immediately after delivery because of the pain and hurdles associated with the administration of insulin. Can sulfonylureas cross into human milk and, if so, is it safe for her to breastfeed her infant?

ANSWER The exposure of infants to second-generation sulfonylureas (eg, glipizide, glyburide) through breast milk is expected to be minimal, based on the limited data available.
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The Use of Botanicals During Pregnancy and Lactation

Tieraona Low Dog, MD

Összefoglaló cikk a várandósság alatt leggyakrabban használt gyógynövények, valamint a galaktogógumok hatásosságáról és biztonságosságáról.

PDF formátumban innen letölthető.
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Methadone exposure during lactation

Miguel Marcelo Glatstein, Facundo Garcia-Bournissen, Yaron Finkelstein, Gideon Koren

Can Fam Physician Vol. 54, No. 12, December 2008, pp.1689 – 1690

QUESTION One of my patients is currently using methadone for maintenance of opioid dependence. She wants to breastfeed. Is breastfeeding safe for her infant?

ANSWER The exposure of infants to methadone through their mothers’ breast milk is minimal. Women using methadone for treatment of opioid dependence should not be discouraged from breastfeeding. The benefits of breastfeeding largely outweigh any theoretical minimal risks.

A teljes cikk a Canadian Family Physician oldalán olvasható.

Canadian Family Physician főoldal
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Pharmacogenetics of Neonatal Opioid Toxicity Following Maternal Use of Codeine During Breastfeeding: A Case–Control Study

P Madadi, CJD Ross, MR Hayden, BC Carleton, A Gaedigk, JS Leeder and G Koren

Clinical Pharmacology & Therapeutics (2008) advance online publication 20 August 2008.

Abstract

A large number of women receive codeine for obstetric pain while breastfeeding. Following a case of fatal opioid poisoning in a breastfed neonate whose codeine prescribed mother was a CYP2D6 ultrarapid metabolizer (UM), we examined characteristics of mothers and infants with or without signs of central nervous system (CNS) depression following codeine exposure while breastfeeding in a case–control study.

Mothers of symptomatic infants (n = 17) consumed a mean 59% higher codeine dose than mothers of asymptomatic infants (n = 55) (1.62 (0.79) mg/kg/day vs.
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