Adverse Drug Reactions in Breastfed Infants: Less Than Imagined

Anderson, Philip O.; Pochop, Stacey L.; Manoguerra, Anthony S.

doi:10.1177/000992280304200405

Cited by 100 publications

(66 citation statements)

References 101 publications

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“…71 In our previous article, 51% of cases involved CNS depressants, and in this study, they account for 69%. 1 Overall, of the 153 cases from our 2 reviews, 88 (58%) cases involved drugs with CNS activity. All deaths reported in this article and in our previous article involved one or more CNS depressants.…”

Section: Discussionmentioning

confidence: 88%

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A Review of Adverse Reactions in Infants From Medications in Breastmilk

Anderson

Manoguerra

Valdés

2015

Clin Pediatr (Phila)

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The types and rate of adverse drug reactions experienced by breastfed infants whose mothers are taking medications has not been well defined. This article reviews the literature on adverse drug reactions in infants since a previous review in 2002. Case reports and studies of adverse drug reactions in breastfed infants whose mothers were taking a prescribed or over-the-counter medication were selected. Fifty-three case reports and 16 studies were located. Serious acute adverse drug reactions from drugs in breastmilk appear to be uncommon. Infants under 2 months of age, and especially those under 1 month, appear to be most susceptible. Similar to previous reviews, free iodine, opioids, and the use of multiple central nervous system drugs simultaneously were identified as drugs of concern. A few narrowly focused studies are now available on long-term effects of maternal drug therapy on breastfed infants and they are mostly reassuring.

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Section: Discussionmentioning

confidence: 88%

“…1 In this article, we used the same methodology to collect and assess case reports since 2002. We also reviewed studies designed to determine the frequency of adverse effects from specific drugs or drug classes.…”

Section: Introductionmentioning

confidence: 99%

A Review of Adverse Reactions in Infants From Medications in Breastmilk

Anderson

Manoguerra

Valdés

2015

Clin Pediatr (Phila)

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“…In addition, unexplained apnea, bradycardia, cyanosis, and sedation have been reported in nursing infants of mothers receiving codeine. 2,66 Hydrocodone is also metabolized via the CYP2D6 pathway. On the basis of pharmacokinetic data, infants exposed to hydrocodone through human milk may receive up to 9% of the relative maternal dose.…”

Section: Pain Medicationsmentioning

confidence: 99%

“…The age of the infant is also an important factor in the decision-making process, because adverse events associated with drug exposure via lactation occur most often in neonates younger than 2 months and rarely in infants older than 6 months. 2 In the near future, pharmacogenetics may also provide important guidance for individualized decisions.…”

Section: Introductionmentioning

confidence: 99%

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Sachs¹

2013

Pediatrics

468

198

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Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (http://toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see http://www.who.int/topics/breastfeeding/en/).

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“…An extensive review of the published literature on adverse reactions from maternal medications in breastfed infants found that 78% of published cases occurred in infants under 2 months of age and only 4% of published cases were in infants over 6 months of age. 9 Infants reported to have adverse reactions involving hydrocodone were 18 days and 5 weeks of age. 2,3 Similarly, the death from codeine and its metabolites in breast milk occurred in a 13-day-old infant.…”

Section: Discussionmentioning

confidence: 99%

Hydrocodone Excretion into Breast Milk: The First Two Reported Cases

Anderson

Sauberan

Lane

et al. 2007

Breastfeeding Medicine

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Hydrocodone is a narcotic that is widely used, often in nursing mothers. Although case reports suggest that hydrocodone in breast milk sometimes may be problematic for the breastfed infant, no reports exist on the amount of its excretion into breast milk. Two mothers who were taking an acetaminophen and hydrocodone combination product donated pumped milk for analysis of hydrocodone. Their infants received an estimated 3.1% and 3.7% of the maternal weight-adjusted dosage, but the absolute hydrocodone dosages were 8.58 microg/kg per day and 3.07 microg/kg per day because of the differences in the dosages ingested by their mothers. Moderate dosages of hydrocodone appear acceptable during breastfeeding, but more data are needed to determine the maximum safe dosage for nursing mothers. Neonates and preterm infants may be more susceptible than older infants to adverse effects of hydrocodone and its metabolites in breast milk.

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Adverse Drug Reactions in Breastfed Infants: Less Than Imagined

Cited by 100 publications

References 101 publications

A Review of Adverse Reactions in Infants From Medications in Breastmilk

A Review of Adverse Reactions in Infants From Medications in Breastmilk

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Hydrocodone Excretion into Breast Milk: The First Two Reported Cases

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