Letters to the EditorDIAZEPAM AND BREAST-FEEDING
References (1)
- E. Cameron
Hyaluronidase and Cancer
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Cited by (83)
Lactation: Contamination of Breast Milk with Xenobiotics
2018, Comprehensive Toxicology: Third EditionThe transfer of drugs and other xenobiotics to the infant via breast milk is a frequent cause for concern. Many women who require pharmacological therapy interrupt or stop breastfeeding, or fail to take the prescribed treatment regimen because of perceived risk to the suckling infant. However, maternal drug therapy should only very rarely preclude breastfeeding. Virtually all drugs (and xenobiotics) transfer into milk, with the extent varying widely between drugs usually in accordance with the principals of passive diffusion. Risk to the suckling infant should be assessed via consideration of the likely “dose” of drug that will be ingested via milk and the infant’s clearance, and the plasma concentration and possible pharmacological effects that result from these. For environmental chemicals, quantifying risk can be challenging due to factors such as inadequate study and uncontrolled “dosing.” For medicines it is usually possible to select an agent that safely treats maternal disease while posing minimal risk to the breastfeeding infant. It is only in very rare instances of severe potential toxicity, such as during maternal chemotherapy, that breastfeeding is best avoided even if the amount transferred into milk is small.
Lactation and Contamination of Breast Milk with Xenobiotics
2010, Comprehensive Toxicology, Second EditionThe health, economic, and sociologic benefits of breastfeeding are substantial. As a result, women are encouraged to exclusively breastfeed their infants until they are around six months of age. However, the transfer of drugs and other xenobiotics to the infant via breast milk is a frequent cause of concern. Many women requiring drug therapy interrupt or stop breastfeeding, or fail to take the prescribed treatment regimen. All drugs, with the exception of very large molecules such as insulin, transfer into milk and may potentially pose risk. However, the extent of transfer varies widely between drugs, usually in accordance with the principles of passive diffusion of unionized and unbound drug. Risk to the suckling infant is best assessed via consideration of the likely ‘dose’ of drug that will be ingested via milk, the infant’s clearance, the plasma concentration that results from these, and the possible pharmacological effects. It is usually possible to select a drug that is safe and effective for the mother while posing minimal risk to her infant. Maternal drug therapy should rarely be a reason to avoid or interrupt breastfeeding. However, in rare instances such as during maternal chemotherapy, breastfeeding is best avoided.
Drugs and chemicals in human milk
2005, Seminars in Fetal and Neonatal MedicineCitation Excerpt :central nervous stimulants, e.g. methylphenidate, amphetamine, atomoxetine Interest in the effect of psychotropic drugs on the infant began with the observation that diazepam administered to the mother was detectable both in her milk and in infant sera and urine.37–39 Active metabolites, desmethyldiazepam, oxazepam, and temazepam were also identified in maternal milk and infant sera.40,41
There is continuing emphasis by many professionals and organizations on the importance of breastfeeding as optimal infant nutrition. Pediatricians are frequently asked about the safety of medications taken by the nursing mother and the risk to the infant. Most drugs and many chemicals will be transferred into milk. For a vast majority of these compounds, there is no risk to the infant. It is almost always possible for the mother to continue nursing while taking the necessary medication. This article presents an introduction to the pharmacology of the transfer of drugs into milk, discusses the importance of the infant's age in assessing safety and presents a number of maternal conditions for which drugs need to be used.
Pharmacology and pharmacokinetics of sedatives and analgesics
2004, Gastrointestinal Endoscopy Clinics of North AmericaShould maternal anesthesia delay breastfeeding? A systematic review of the literature
2019, Brazilian Journal of AnesthesiologyA importância e os benefícios do aleitamento materno para os bebês e para as mães estão bem estabelecidos e documentados na literatura. No entanto, é frequente que mães lactantes precisem se submeter à anestesia geral ou raquianestesia e, devido à falta de informações, muitas delas interrompem a amamentação após a anestesia. Existem poucos dados disponíveis sobre a transferência de anestésicos para o leite materno. O objetivo desta revisão foi desenvolver algumas considerações e recomendações com base na literatura disponível.
Uma busca sistemática da literatura realizada usando com os seguintes bancos de dados em ciências da saúde: Embase, Lilacs, Pubmed, Scopus e Web of Science. A pesquisa bibliográfica mais recente foi realizada em 6 de abril de 2018. Uma pesquisa bibliográfica adicional foi realizada através do site da Organização Mundial da Saúde. Usamos os seguintes termos para a estratégia de busca: “Anestesia” e “Aleitamento materno” e seus derivados.
Nesta pesquisa, 599 registros foram encontrados e 549 foram excluídos por diferentes razões. Foram incluídos 50 manuscritos, com diferentes modelos de estudo: estudos prospectivos, estudos observacionais retrospectivos, revisões, relatos de casos, ensaios clínicos randômicos, caso‐controle e acesso a sites. Pequenas concentrações da maioria dos agentes anestésicos são transferidas para o leite materno; entretanto, sua administração parece ser segura para mães lactantes quando administrados em dose única durante a anestesia e isso não deve contraindicar o aleitamento materno. Por outro lado, altas doses, administração contínua ou repetida dos fármacos aumentam o risco de efeitos adversos em neonatos e devem ser evitados. Poucas drogas, como diazepam e meperidina, produzem efeitos adversos em bebês amamentados, mesmo quando administradas em doses únicas. Dexmedetomidina parece ser segura se a amamentação começar 24 horas após a interrupção do medicamento.
A maioria dos anestésicos é segura para mães que amamentam e oferecem baixo risco para os recém‐nascidos amamentados quando a administração é em dose única. No entanto, altas doses e repetidas administrações de drogas aumentam significativamente o risco de efeitos adversos em recém‐nascidos. Além disso, diazepam e meperidina devem ser evitados em mulheres que amamentam. Finalmente, anestesiologistas e pediatras devem considerar o risco‐benefício individual, com atenção especial para os recém‐nascidos prematuros ou bebês com doenças concomitantes, pois são mais suscetíveis a efeitos adversos.
The importance and benefits of breastfeeding for the babies and mothers are well established and documented in the literature. However, it is frequent that lactating mothers need to undergo general or spinal anesthesia and, due to the lack of information, many of them interrupt breastfeeding after anesthesia. There are limited data available regarding anesthetics transfer to breast milk. This review aims to develop some considerations and recommendations based on available literature.
A systematic search of the literature was conducted by using the following health science databases: Embase, Lilacs, Pubmed, Scopus, and Web of Science. The latest literature search was performed on April 6th, 2018. Additional literature search was made via the World Health Organization's website. We used the following terms for the search strategy: “Anesthesia” and “Breastfeeding”, and their derivatives.
In this research, 599 registers were found, and 549 had been excluded by different reasons. Fifty manuscripts have been included, with different designs of studies: prospective trials, retrospective observational studies, reviews, case reports, randomized clinical trials, case–control, and website access. Small concentrations of the most anesthetic agents, are transferred to the breast milk; however, their administration seem to be safe for lactating mothers when administered as a single dose during anesthesia and this should not contraindicate the breastfeeding. On the other hand, high‐doses, continuous or repeated administration of drugs increase the risk of adverse effects on neonates, and should be avoided. Few drugs, such as diazepam and meperidine, produce adverse effects on breastfed babies even in single doses. Dexmedetomidine seems to be safe if breastfeeding starts 24 h after discontinuation of the drug.
Most of the anesthetic drugs are safe for nursing mothers and offer low risk to the breastfed neonates when administered in single‐dose. However, high‐dose and repeated administration of drugs significantly increase the risk of adverse effects on neonates. Moreover, diazepam and meperidine should be avoided in nursing women. Finally, anesthesiologists and pediatricians should consider individual risk/benefit, with special attention to premature neonates or babies with concurrent diseases since they are more susceptible to adverse effects.
Management of anxiolytics and hypnotics during pregnancy and breastfeeding
2018, Psiquiatria BiologicaSe revisa el uso de ansiolíticos e hipnóticos durante el embarazo y la lactancia, analizando su efecto teratógenico, así como los síndromes perinatales descritos y los posibles efectos en el desarrollo del neonato, concluyéndose que la evidencia de los estudios es insuficiente para garantizar que no existirán problemas relevantes, pero estos parecen ser infrecuentes, en términos absolutos. En líneas generales, sería deseable evitar el uso de benzodiazepinas durante el primer trimestre, especialmente las semanas 3.a a 11.a, por el mayor riesgo de teratogenicidad, pero siempre que se disponga de otra opción alternativa que vaya a cumplirse y que la misma resulte eficaz. Sin embargo, pueden usarse si, estando indicadas, no existe la posibilidad de utilizar otras alternativas mejores, sean estas farmacológicas o no farmacológicas.
A review is presented on the use of anxiolytics and hypnotics during pregnancy and lactation. An analysis is made on their teratogenic effect, as well as the associated perinatal syndromes and the possible effects on the development of the newborn child. It is concluded that the evidence from the studies is insufficient to ensure that their use is safe, although it seems that there are few complications. In general, efforts should be made to avoid the use of benzodiazepines during the first trimester, especially in weeks 3 to 11, due to the increased risk of teratogenicity, and provided that another alternative is available and considered effective. They can be used if there is no feasible and better pharmacological or non-pharmacological alternative, and there is a clinical indication.