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Excretion of citalopram in breast milk

Olav Spigset, Lena Carleborg, Robert Öhman & Åke Norström
Br J Clin Pharmacol 1997; 44: 295–298

Abstract

Aims The objective of this study was to measure the secretion of the selective serotonin uptake inhibitor citalopram in breast milk.

Methods The excretion of citalopram in breast milk was studied at steady-state conditions in two patients with depression and in one healthy volunteer after ingestion of a single dose citalopram.

Results Milk/serum concentration ratios based on single pairs of samples from the two patients ranged from 1.16 to 1.88. Based on milk concentration data from the patients, the absolute dose ingested by a suckling infant would be 4.3–17.6 μg kg−1 day−1, and the relative dose 0.7–5.9% of the weight-adjusted maternal dose.
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Drug distribution in human milk – Dental implications

Prepared by Dr R.G. Woods of the Australian Dental Association

Aust Prescr 1997;20:51

Practical, clinical issues concerning drugs in human milk arise frequently in dentistry because mothers present for elective treatment which has been postponed during pregnancy. Treatment provided for nursing mothers may be third molar surgery, periodontal treatment, prophylaxis, endodontic care or dental restorative procedures. Nursing mothers are generally concerned about any possible effect dental treatment, including drugs, may have on their milk or on the nursing infant.

Where single doses of drugs are used, e.g. local anaesthetics or parenterally administered sedatives, the effects on human milk are likely to be minimal.
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Drug distribution in human milk

Kenneth F. Ilett, Judith H. Kristensen

Aust Prescr 1997;20:35-40

Summary

Assessing the safety of breast feeding during maternal drug therapy is an individualised risk:benefit analysis. An infant’s exposure depends on drug transfer into milk, daily milk intake and the bioavailability of the drug in the infant. Exposure and the potential for adverse effects is greatest in premature neonates and decreases over the first few months of life as the infant’s clearance mechanisms mature. Risk should be assessed in the light of the inherent toxicity of the drug and any published data on milk transfer and infant exposure. When maternal drug therapy is necessary, the breast-fed infant should be regularly assessed for adverse effects such as sedation, failure to thrive and achievement of developmental milestones.
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Maternal Medication Use During Breastfeeding

Pediatric Pharmacotherapy
Volume 2, Number 4, April 1996

Assessing and Minimizing the Risk

Assessing the risk of maternal medication use in the breastfeeding infant continues to be one of the more difficult tasks faced by health care providers in obstetrics, pediatrics, and family medicine. Despite the dramatic increase in the percentage of women choosing to breastfeed, our knowledge of the safety of most medications remains limited. Research into the quantity of drug transferred into milk is complex and provides only a limited degree of certainty on the safety of medication use. However, this lack of scientific data should not lead to the conclusion that most medications are unsafe.
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Distribution and excretion of sumatriptan in human milk

R. E. WOJNAR-HORTON, L. P. HACKETT, P. YAPP, L. J. DUSCI, M. PAECH, K. F. ILETT
Br J Clin Pharmacol 1996; 41: 217-221

Abstract

  1. The excretion of a 6 mg subcutaneous dose of sumatriptan in breast milk was studied in five lactating volunteer subjects with a mean age of 27.6 years and a mean body weight of 75 kg. Drug concentrations in milk and plasma over the ensuing 8 h were measured by high-performance liquid chromatography.
  2. The mean milk:plasma ratio estimated from the areas under the milk and plasma concentration-time curves (AUC) was 4.9 (95% CI 4.1–5.7), indicating a significant transfer of sumatriptan into the milk compartment.

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Excretion of fluoxetine and its metabolite, norfluoxetine, in human breast milk

A Taddio, S Ito, and G Koren

The Journal of Clinical Pharmacology, 1996; 36:42-47

A study was conducted to measure breast milk concentrations of fluoxetine and its active metabolite, norfluoxetine, excreted in breast milk in a cohort of nursing women using fluoxetine, and to estimate infant dose from nursing.

The study included 10 women nursing 11 infants (median age, 185 days). The mean fluoxetine dose was 0.39 mg/kg/day. Each patient manually collected 3 to 6 milk samples throughout a dosing interval. Concentrations of fluoxetine and norfluoxetine in milk were measured by gas-liquid chromatography. Mothers reported whether they observed adverse effects in their infants.
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