Studying Drugs in Human Milk: Time to Unify the Approach

Begg, Evan J.; Duffull, Stephen B.; Hackett, L.P.; Ilett, Kenneth F.

doi:10.1177/089033402237904

Cited by 113 publications

(110 citation statements)

References 38 publications

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“…The dose of a drug that an infant receives during breastfeeding is dependent on the average plasma concentration of drug in the mother, the amount excreted into breast milk, and the daily volume of milk ingested by the infant [27,28]. The ability of an infant to absorb and eliminate a drug will also determine exposure; the younger the infant, the more likely that elimination will contribute to adverse events.…”

Section: Drug Safety During Lactationmentioning

confidence: 99%

Medication use in the treatment of migraine during pregnancy and lactation

Lucas

2009

Current Science Inc

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Migraine is very common in women of reproductive age. With peak prevalence of migraine occurring during childbearing years, many women with migraine may knowingly or unknowingly use medication during pregnancy. Although migraine tends to improve during pregnancy, many women may still experience moderate to severe disabling headache and need pharmacologic treatment for the pain, nausea, and vomiting. This article explores the physiologic changes occurring during pregnancy that can affect pharmacokinetic properties of drugs and their metabolism. Acute and preventive treatment of migraine during pregnancy and lactation is discussed, with an emphasis on safety to the fetus and nursing infant. Safety and recommended use of medication during pregnancy may be different when use is considered during breastfeeding. A goal of treatment is to balance potential risk of treatment to the fetus and nursing infant with significant relief and return to normal function of the mother.

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Section: Drug Safety During Lactationmentioning

confidence: 99%

Medication use in the treatment of migraine during pregnancy and lactation

Lucas

2009

Current Science Inc

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“…Le pH du lait est en moyenne égal à 6,98, 6,90 et 6,80 aux jours 3, 4 et 5 post partum, respectivement. Dans le lait mature, il varie entre 6,60 et 6,95 [48,49].…”

Section: Réabsorptionunclassified

“…En effet, même s'il est élevé, la quantité de médicament qui passe dans le lait est avant tout déterminée par sa concentration dans le sang de la mère. En effet, si un médicament a un rapport L/P élevé et si le taux plasmatique chez la mère de ce médicament est bas, la quantité de médicament qui passera dans le lait sera faible de toute façon [13,34,49,57]. C'est la raison pour laquelle les pharmacologues s'attachent à mesurer l'évolution des concentrations du médica-ment en fonction du temps dans le lait et dans le plasma, ce qui fournit des données beaucoup plus fiables, et même indispensables pour les médicaments dont les concentrations n'évoluent pas en parallèle entre les différents compartiments biologiques (bupropion, sumatriptan, sertraline, paroxétine.…”

Section: Estimation De L'exposition Du Nourrisson Au Médicamentunclassified

“…Les pédiatres s'accordent à définir une limite arbitraire de 10 % de la dose maternelle, en deçà de laquelle les effets cliniques sont très probablement insignifiants pour des nouveaunés nés à terme et en bonne santé [13,49,51,57]. Il est à noter que la quantité de métabolites actifs doit être prise en compte dans le calcul de la quantité de médicament à laquelle l'enfant au sein est exposé [31].…”

Section: Dose Enfant Relativeunclassified

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Passage des benzodiazépines dans le lait maternel : aspects cliniques et analytiques

Khachman¹,

Gandia

Sena

et al. 2008

Ann Toxicol Anal

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Résumé -Mots clés : Lait, suivi biologique thérapeutique, benzodiazépines, HPLC Abstract -Objective: To validate an HPLC analytical assay of benzodiazepines in milk to assess the degree of exposure of the breastfed infant and set up a therapeutic drug monitoring. Methods: The linearity, the recovery, the within-day repetability and inter-day reproductibility over three days of diazepam, desmethyldiazepam, bromazepam, oxazepam and lorazepam were studied with three different matrices, cow's milk Candia , freeze-dried milk dedicated for infants O-Lac Enfamil and mother breast milk. Midazolam was used as internal standard. The chromatographic system consisted of a Nucleosil column with an UV detection (254 nm). The flow of the pump was adjusted at 1.2 mL/min with an acquisition period of 20 min. Results: The linearity for diazepam, bromazepam and lorazepam ranged from 50 to 5000 ng/mL whereas for desmethyldiazepam and oxazepam, it ranged from 100 to 10 000 ng/mL (r 2 > 0.99). The recovery was around 100% (± 15%) for each tested benzodiazepine. Within-day and inter-day coefficients of variation (CV) for the five benzodiazepines ranged from -15.3% to 17.4%. Conclusion: The validated method is simple, fast and applicable to maternal milk samples containing benzodiazepines.

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“…Infant exposure to maternal medication is a major concern, because the principal organs involved in drug metabolism and excretion (the liver and kidneys) are immature, which increases the risk of drug accumulation and adverse events [10,11]. …”

Section: Introductionmentioning

confidence: 99%

Antibiotics and Breastfeeding

et al. 2016

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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.

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Studying Drugs in Human Milk: Time to Unify the Approach

Cited by 113 publications

References 38 publications

Medication use in the treatment of migraine during pregnancy and lactation

Medication use in the treatment of migraine during pregnancy and lactation

Passage des benzodiazépines dans le lait maternel : aspects cliniques et analytiques

Antibiotics and Breastfeeding

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