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    Drugs in Lactation

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    corzpun168678
    This document discusses drugs taken during lactation and their classification. It divides drugs into five categories: compatible with breastfeeding, compatible but monitor infant for side effects, avoid if possible and monitor infant, avoid as they may inhibit lactation, and avoid as they pose dangerous side effects to the infant. Each drug category provides examples of common drugs that fall in that category along with their potential effects on the breastfeeding infant. The document emphasizes minimizing infant exposure to drugs through a mother's milk and provides recommendations for monitoring or alternative feeding if needed.

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    Drugs in Lactation

    Uploaded by

    corzpun168678
    340 views36 pages
    This document discusses drugs taken during lactation and their classification. It divides drugs into five categories: compatible with breastfeeding, compatible but monitor infant for side effects, avoid if possible and monitor infant, avoid as they may inhibit lactation, and avoid as they pose dangerous side effects to the infant. Each drug category provides examples of common drugs that fall in that category along with their potential effects on the breastfeeding infant. The document emphasizes minimizing infant exposure to drugs through a mother's milk and provides recommendations for monitoring or alternative feeding if needed.

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    This document discusses drugs taken during lactation and their classification. It divides drugs into five categories: compatible with breastfeeding, compatible but monitor infant for side effects, avoid if possible and monitor infant, avoid as they may inhibit lactation, and avoid as they pose dangerous side effects to the infant. Each drug category provides examples of common drugs that fall in that category along with their potential effects on the breastfeeding infant. The document emphasizes minimizing infant exposure to drugs through a mother's milk and provides recommendations for monitoring or alternative feeding if needed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    340 views36 pages

    Drugs in Lactation

    Uploaded by

    corzpun168678
    This document discusses drugs taken during lactation and their classification. It divides drugs into five categories: compatible with breastfeeding, compatible but monitor infant for side effects, avoid if possible and monitor infant, avoid as they may inhibit lactation, and avoid as they pose dangerous side effects to the infant. Each drug category provides examples of common drugs that fall in that category along with their potential effects on the breastfeeding infant. The document emphasizes minimizing infant exposure to drugs through a mother's milk and provides recommendations for monitoring or alternative feeding if needed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 36

    DRUGS IN

    LACTATION
    Topics

    I. Facts about drugs in lactation


    II. Classification of drugs in lactation
    III. Effects of drugs on the Mother &
    Baby
    IV. Measures to Minimize Effect of
    Maternal medication
    II. Classification of Drugs for
    Breastfeeding

    (As to Recommendation during


    Lactation)
    I. FACTS ABOUT DRUGS IN LACTATION

    1. Most drugs pass through breastmilk.


    2. 1% less of maternal dose appear in
    breastmilk.
    3. Few drugs are contraindicated.
    4. Some drugs cause side effects on
    the baby.
    5. Baby’s exposure to a drug can be
    minimized.
    I. COMPATIBLE WITH
    BREASTFEEDING
    Safe and No Contraindication
    Exception

    1. Anesthetics • Sevoflurane
    • Ketamine
    • Bupivacaine Hcl
    2. Antihistaminics • Diphenhydramine
    Hcl
    • Loratadine
    3. Hypnosedative • Midazolam
    • Diazepam
    compatible

    Exception

    4. Muscle • Suxamethonium Dantrolene


    Relaxant • Vecuronium

    5. Anti-secretory • Cimetidine Omeprazole


    GIT • Ranitidine Misoprostol

    6. Analgesic • Paracetamol NSAID


    /Antipyretics • Acetaminophen 2nd Generation
    • NSAid (1st Celecoxib
    generation)
    compatible

    Exception

    7. Steroid • Dexamethesone compatible


    (single)
    • Hydrocortisone
    (single)
    8. Antibacterial • Erythromycin
    • Amoxicillin
    • Ampicillin
    • Cloxacillin
    9. • Captopril (capoten)
    Antihypertensive • Methyldopa
    (Aldomet)
    compatible

    Exception

    10. Antidysrrhythmia • Lidocaine Hcl Amioda-


    • Quinidine rone

    11. Cardiac Glycoside • Digitoxin


    • Digoxin
    compatible

    12. Anti-asthma /Anti- • Salbutamol


    oxytoxic
    13. Antitussives • Codeine (single
    dose
    • Ammonium
    Chloride
    compatible

    Exception

    14. Oxytocin • Oxytocin (short


    term)
    15. Diuretics • Mannitol
    • Spirinolactone
    16. Dermatological • Selenium Sulfide
    Antifungal
    17. Opthalmological • Acetazolamide
    Antiglaucoma
    18. Cytotoxic Drugs • Calcium Folinate
    compatible

    Exception

    19. Immunologicals • Antitetanus


    Immunoglobuline Immunoglobuline
    • Diptheria
    Antitoxin

    • BCG • Smallpox
    Vaccine
    • Measles vaccine
    20. Vitamins • Ascorbic in usual
    dose
    • Thiamine
    21. Antithyroid • Levothyroxine
    RECOMMENDATION:

    Take the drugs and


    continue to breastfeed
    II. Compatible with Breastfeeding but Monitor
    Infant for Side Effects
    (minor side effects but rare)

    Side Effects
    1. Anti- • AtSO4 • Drying of
    cholinergic secretion
    • Increase
    temperature
    2. Antiemetics • Metoclopramide

    3. Analgesics • Pethidine in
    occasional dose
    • Morphine in
    occasional dose
    Compatible but monitor

    Side Effects

    4. Anti-TB Drugs • Rifampicin Jaundice


    • Streptomycin
    • Ethambutol

    5. Vitamin • Ascorbic acid Hemolysis


    (large dose Jaundice

    6. Antibacterial • Gentamycin Thrush &


    diarrhea

    7. Antiasthma • Aminophylline Irritability

    8. Antiangina • Verapamil
    Compatible but monitor

    Side Effects

    9. Antihypertensive • Hydralazine
    (apresoline)
    • Nifedipine

    10. Diagnostic Agent • Propyliodine Hypothyroidism

    11. Anticonvulsant • Phenobarbital • Drowsiness


    (luminal) • Poor suckling /
    weight gain
    • MgSO4
    12. Analgesic /Anti- • ASA (occasional
    dose)
    pyretic
    RECOMMENDATIONS:

    Notify mother….

    If + side effects  stop taking the drugs


    and find alternative
    If mother cannot stop taking the drugs
     stop breastfeeding
    and feed with pasteurized milk

    Continue milk expression


    III. Avoid if Possible, monitor for
    side effects
    (repeated doses  serious side effects)
    1. Antihistaminic • Chlorphenamine • Drowsiness
    • Irritability
    2. Hypnosedative • Diazepam • Drowsiness

    3. Opioid • Pethidine • Apnea


    Analgesic • Morphine • Bradycardia

    4. Antibiotics • Tetracycline • Teeth


    staining
    • Chlorampenicol • Hemolysis
    • Jaundice
    Avoid if possible

    5. Disinfectant • Povidone • Hypothyroidism


    Iodine
    (Topical)
    6. Anti-angina • Atenolol • Bradycardia
    / Antihypertensive • Hypotension
    • Cyanosis
    7. • Chlorpromazine • Drowsiness
    Psychotherapeutic • Restlessness
    • Lithium • Weakness
    • Poor muscle
    tone

    8. Antibacterial • Metronidazole
    Avoid if possible

    9. Antitussives • Codeine in • Apnea


    repeated doses • Bradycardia
    • Cyanosis
    10. Ethanol • Chronic use of • Drowsiness
    Intake alcohol • Poor growth
    • Weakness

    11. Caffeine • Excessive • Wakefulness


    dosage • Hyperactivity
    • Poor sleeping
    pattern
    • Irritability
    RECOMMENDATIONS:
    • Use when essential for mother’s Rx and
    no safer alternative
    • Continue breastfeeding and observe the
    baby for any changes
    • Follow up
    + side effects  stop the drugs
    If not possible to stop the drugs 
    stop BF and use pasteurized milk.
    • Milk expression
    IV. Avoid if Possible
    (May Inhibit Lactation)

    1. Anti-cholinergic • AtSO4 (repeated doses

    2. Anti-gout • Colchicine

    3. Diuretics • Furosemide
    • Hydrochlorothia-zide
    4. Oxytocin • Ergometrine (repeated doses)
    • Oxytocin (prolonged use)
    (May Inhibit Lactation)

    5. Hormonal Con- •Ethinylestradiol


    traceptives •Levonorgestril
    •Ethinyl estradiol
    + Norethisterone

    6. Anti-parkinsonism • Carbidopa
    • Levodopa
    7. Excess Nicotine Intake • Cigarettes more than
    20/day

    8. Anti-migraine • Ergot alkaloid


    • Ergot ergotamine
    RECOMMENDATION:

    Frequent Suckling
    of the Breast
    V. Avoid (Dangerous Side Effects on
    the Baby)

    1. Anti-neoplastic • Cytotoxic
    – Cisplatin
    – Vincristine
    – Methotrexate

    • Immunosuppresive
    – Ciclosporin
    – Azathioprine
    AVOID

    2. Radiopharmaceutical Anti-thyroid Cause


    - iodine 131 or Na iodide damage to
    nursing infant
    (Na 131)
    thyroid
    Increase risk
    Elimination of Radio-iodine from of thyroid CA
    the milk
    Na 131 - 14 days
    Iodine 123 - 36 hours
    125 - 12 days
    AVOID

    3. Hallucinogenic • Marijuana • Irritability


    • LSD • Poor feeding
    • PCP (Phen-
    cyclidine)
    4. Anorexant / • Phentermine • CNS stimulation
    Appetite, • Amphetamine may occur in
    suppresant nursing infant
    5. Anti-lipemic • Simvastatin
    • Fluvastatin
    RECOMMENDATION:

    Stop breastfeeding until


    treatment is completed
    Is there a drug that is
    absolutely safe?
    EFFECTS OF DRUGS TO THE MOTHER
    1. Estrogen /Thiazide • Suppress lactation

    2. Rifampicin (Orange) • Colors breastmilk

    Flavors breast milk


    3. Metronidazole • (Bitter taste) Onion, Garlic
    • (Radiographic Contrast
    Media) metalic taste
    Iothalamate

    4. Metoclopramide • Increase lactation

    5. Nicotine • Decrease milk production


    EFFECTS OF DRUGS TO THE BABY

    • Lethargy
    1. Diazepam
    • Drowsiness
    / Phenobarbital
    • Sedation
    2. Chlorphenamine • Irritability
    / Theophylline
    3. Indomethacin • Convulsion
    4. Phenobarbital • Poor suckling
    / Carbamazepine • Poor weight gain
    EFFECTS OF DRUGS TO THE BABY

    5. Clindamycin • Bloody Diarrhea

    6. Gentamycin • Diarrhea /Thrush


    / Streptomycin
    7. AtSO4 • Fever
    • Drying of
    secretion
    8. Penicillin • Rashes
    9. Anti-TB • Jaundice
    /Ascorbic Acid (large doses)
    / Chloramphenicol
    EFFECTS OF DRUGS TO THE BABY

    10. Lithium • Restlessness


    • Weakness
    • Poor muscle tone
    11. Propranolol • Hypoglycemia
    • Cyanosis
    12. Nicotine • Vomiting
    (chewing gum) • Tachycardia
    • Restlessness
    13. ASA • Hemolysis
    • Prolonged bleeding time
    EFFECTS OF DRUGS TO THE BABY

    14. K Iodide • Hypothyroidism


    / Povidone Iodine

    15. Caffeine • Hyperactivity


    • Wakefulness
    • Slow excretion
    • Poor sleeping pattern
    16. Tetracycline • Staining teeth
    17. Morphine • Apnea
    / Pethidine • Bradycardia
    18. Morphine • Urinary Retention
    MEASURES TO MINIMIZE EFFECT OF
    MATERNAL MEDICATION

    • Avoid long acting forms of drug.


    • Schedule the dose
    • Choose the safest drug
    • Watch out for signs and
    symptoms
    • If a drug may present a risk to the
    infant measure blood
    concentrations.
    Medicines in Lactation

    judgement
    1. Requirement
    careful assessment
    of Risk vs. Harm

    indication
    2. Usage
    proven benefits
    The use of medicine in lactation
    • Requires a balance of judgement and
    careful assessment of the risk of not giving
    against any possible potential harm from
    its use
    • Medicines should only be used in lactation
    if it is clearly indicated and of proven
    benefits to the mother and baby.
    Salamat Po !

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