Bejegyzés

Lamotrigine in Breast Milk and Nursing Infants: Determination of Exposure

D. Jeffrey Newport, Page B. Pennell, Martha R. Calamaras, James C. Ritchie, Melanee Newman, Bettina Knight, Adele C. Viguera, Joyce Liporace and Zachary N. Stowe

PEDIATRICS Vol. 122 No. 1 July 2008, pp. e223-e231

Abstract

OBJECTIVE. Although lamotrigine use during pregnancy has substantially increased over the past decade secondary to accumulated reproductive safety data, systematic data on lamotrigine during breastfeeding remains sparse. We sought to characterize the determinants of lamotrigine concentrations in breast milk and nursing-infant plasma.

PATIENTS AND METHODS. Women who enrolled in a prospective investigation of perinatal medication pharmacokinetics, were treated with lamotrigine, and chose to continue lamotrigine while breastfeeding were included in the analysis.
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Use of a sparse sampling study design to assess transfer of tramadol and its O-desmethyl metabolite into transitional breast milk

Kenneth F. Ilett, Michael J. Paech, Madhu Page-Sharp, Sherwin K. Sy, Judith H. Kristensen, Raymond Goy, Sebastian Chua, Tracey Christmas & Karen L. Scott
British Journal of Clinical Pharmacology Volume 65, Issue 5, Date: May 2008, Pages: 661-666

Abstract

What is already known about this subject

  • There are presently no published data on tramadol transfer into breast milk or on its effects in the breastfed infant.

What this study adds

  • We have provided quantitative data on the absolute and relative infant doses of rac-tramadol and it rac-O-desmethyl metabolite for the breastfed infant.
  • We have also demonstrated a novel sparse sampling data collection method for investigating infant exposure via milk.

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Mechanisms of Drug Entry into Human Milk

The amount of drug excreted into milk depends on a number of kinetic factors:

  1. the lipid solubility of the drug,
  2. the molecular size of the drug,
  3. the blood level attained in the maternal circulation,
  4. protein binding in the maternal circulation,
  5. oral bioavailability in the infant, and the mother, and
  6. the half-life in the maternal and infant’s plasma compartments.


Using these kinetic terms, one can frequently estimate the probability that a medications will enter will.But the only true test are the research studies published in the literature.With these in hand, we can frequently estimate the absolute dosage an infant will receive from his/her mothers’ milk.
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Use of sparse sampling study design to assess transfer of tramadol and its O-desmethyl metabolite into transitional breast milk

Kenneth F. Ilett, Michael J. Paech, Madhu Page-Sharp, Sherwin K. Sy, Judith H. Kristensen, Raymond Goy, Sebastian Chua, Tracey Christmas, Karen L. Scott (2008)

British Journal of Clinical Pharmacology doi:10.1111/j.1365-2125.2008.03117.x

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

  • There are presently no published data on tramadol transfer into breast milk or on its effects in the breastfed infant.

WHAT THIS STUDY ADDS

  • We have provided quantitative data on the absolute and relative infant doses of rac-tramadol and it rac-O-desmethyl metabolite for the breastfed infant.
  • We have also demonstrated a novel sparse sampling data collection method for investigating infant exposure via milk.

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Excretion of Ketoprofen and Nalbuphine in Human Milk During Treatment of Maternal Pain After Delivery

Jacqz-Aigrain, Evelyne MD, PhD; Serreau, Raphael MD; Boissinot, Christine MD; Popon, Michel; Sobel, Alain MD; Michel, Jacqueline MD; Sibony, Oliver MD, PhD

Therapeutic Drug Monitoring. 29(6):815-818, December 2007.

Abstract

Analgesics are required to prevent and treat postpartum pain, but breast-feeding may be contraindicated, because data on milk transfer are very limited. The present study was undertaken to quantify the transfer of ketoprofen and nalbuphine in milk. Eighteen patients gave their informed consent to participate and completed the study. Following delivery, they received ketoprofen (100 mg/12 hours) and nalbuphine (0.2 mg/kg/4 hours) as an intravenous bolus over 2 to 3 days for postpartum pain.
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Use of Codeine By Some Breastfeeding Mothers May Lead To Life-Threatening Side Effects In Nursing Babies

FDA has important new information about a very rare, but serious, side effect in nursing infants whose mothers are taking codeine. Differences in drug metabolism among mothers taking codeine may contribute to side effects in nursing infants.

Infants of nursing mothers taking codeine may have an increased risk of morphine overdose if the mother is an ultra-rapid metabolizer of codeine. When codeine enters the body and is metabolized, it changes to morphine, which relieves pain. Many factors affect codeine metabolism, including a person’s genetic make-up. Some people have a variation in a liver enzyme and may change codeine to morphine more rapidly and completely than other people.
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Lactation Safety Recommendations and Reliability Compared in 10 Medication Resources

Monica Akus, PharmD BCPS CACP, Melissa Bartick, MD MS

The Annals of Pharmacotherapy: Vol. 41, No. 9, pp. 1352-1360. 2007 July

Abstract

BACKGROUND: Discontinuation of breast-feeding is linked with an increased risk of acute and chronic diseases in children, as well as increased risk of maternal disease. Mothers and physicians often depend on pharmacists for accurate drug information. Their information is only as good as the sources available to them.

OBJECTIVE: To determine the reliability of safety recommendations for drugs used during lactation, based on current research and information, and determine whether resources may be inappropriately advising the interruption of breast-feeding.
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Therapy Insight: The Use of Antirheumatic Drugs During Nursing

Monika Østensen; Mario Motta

Nature Clinical Practice Rheumatology 2007 Jul;3(7):400-6. Review.

Summary

In 90% of cases, women with rheumatoid arthritis suffer a disease flare within 3 months of delivery of their baby. Drug treatment is, therefore, required; however, such therapies have implications for mothers who decide to nurse their infants. Unfortunately, because of a paucity of data, little is known about the transfer of antirheumatic drugs into breast milk, and even less is known about whether small amounts of these agents ingested during nursing could harm the infant. Our review of the literature indicates that paracetamol, prednisone, antimalarial agents, sulfasalazine and most NSAIDs can safely be used by lactating mothers.
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Breastfeeding and radiologic procedures

Jack Newman

Can Fam Physician Vol. 53, No. 4, April 2007, pp.630 – 631

QUESTION Recently, some of my patients were instructed not to breastfeed for 24 to 48 hours after magnetic resonance imaging scans. Is this based on scientific evidence?

ANSWER No. On the contrary, evidence indicates unequivocally that the contrast media used for both magnetic resonance imaging and computed tomography scans are excreted into breast milk in such small quantities that there is no concern at all for nursing babies.

A teljes cikk a Canadian Family Physician oldalán olvasható.

Canadian Family Physician főoldal
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Fájdalomcsillapítás és érzéstelenítés szoptató anyák számára

ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother

Az Academy of Breastfeeding Medicine 15. számú protokollja

ANNE MONTGOMERY, THOMAS W. HALE, and THE ACADEMY OF BREASTFEEDING MEDICINE PROTOCOL COMMITTEE
BREASTFEEDING MEDICINE Volume 1, Number 4, 2006

A vizsgálat célja

A vajúdás, a szülés és a szoptatás megkezdése mind normális folyamat. A vajúdás során fellépő fájások hatására termelődő oxitocin, endorfin és adrenalin fontos szerepet játszik abban, hogyan zajlik a szülés, és hogyan kezdődik a szoptatás. (1) A fájdalomcsillapításra használt szerek a vajúdás és a postpartum időszak alatt megkönnyítik a szülést és segítenek a szülés utáni felépülésben, különösen császármetszés után.
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