Szoptatás Portál ... naprakész információk a szoptatásról

Miguel Marcelo Glatstein, Facundo Garcia-Bournissen, Yaron Finkelstein, Gideon Koren

Can Fam Physician Vol. 54, No. 12, December 2008, pp.1689 - 1690

QUESTION One of my patients is currently using methadone for maintenance of opioid dependence. She wants to breastfeed. Is breastfeeding safe for her infant?

P Madadi, CJD Ross, MR Hayden, BC Carleton, A Gaedigk, JS Leeder and G Koren

Clinical Pharmacology & Therapeutics (2008) advance online publication 20 August 2008.

Abstract

A large number of women receive codeine for obstetric pain while breastfeeding. Following a case of fatal opioid poisoning in a breastfed neonate whose codeine prescribed mother was a CYP2D6 ultrarapid metabolizer (UM), we examined characteristics of mothers and infants with or without signs of central nervous system (CNS) depression following codeine exposure while breastfeeding in a case–control study.

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.

Aims To investigate the transfer of rac-tramadol and its rac-O-desmethyl metabolite into transitional milk, and assess unwanted effects in the breastfed infant.

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.

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. Milk samples were collected during the 12 hours between the third and fourth ketoprofen administrations. Ketoprofen and nalbuphine concentrations were determined with high-performance liquid chromatography.

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. These people are ultra-rapid metabolizers and are more likely to have higher than normal levels of morphine in their blood after taking codeine. Nursing mothers taking codeine may also have higher morphine levels in their breast milk. These higher levels of morphine in breast milk may lead to life-threatening or fatal side effects in nursing babies. In most cases, it is unknown if someone is an ultra-rapid codeine metabolizer.

Philip O. Anderson, Jason B. Sauberan, James R. Lane, Steven S. Rossi
Breastfeeding Medicine. 2007, 2(1): 10-14.

Abstract

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 μg/kg per day and 3.07 μg/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.

Forrás

Parvaz Madadi, Gideon Koren, James Cairns, David Chitayat, Andrea Gaedigk, J. Steven Leeder, Ronni Teitelbaum, Tatyana Karaskov, Katarina Aleksa

Can Fam Physician Vol. 53, No. 1, January 2007, pp.33 - 35

QUESTION Recently a newborn died from morphine poisoning when hismother used codeine while breastfeeding. Many patients receive codeine for postlabour pain. Is it safe to prescribe codeine for nursing mothers?

Begg EJ, Malpas TJ, Hackett LP, Ilett KF.
Br J Clin Pharmacol. 2001 Dec;52(6):681-5.

Abstract

Aims To measure the interdose milk to plasma ratio (M/P) of R- and S-methadone during multiple dosing in lactating mothers taking medium to high doses of methadone (> 40 mg daily), and to assess likely infant exposure.