Review Note
Last Update: 03/02/2025 09:56 AM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
Front
Back
No published tags.
Pending Suggestions
Field Change Suggestions:
Front
Commit #292859
SS_OB 1.15 Outline the potential effects on the neonate of drug administration in association with lactation
Back
Commit #292859- For drugs to be transferred to a neonate through breastfeeding, they must be secreted in the milk and absorbed in the neonatal GI tract and must not undergo extensive 1st-pass metabolism in the neonatal liver
- the neonatal serum concentration of a drug is <2% of maternal serum concentration, resulting in a subtherapeutic dose. Most drugs are therefore safe
- Factors that make significant transfer more likely include low maternal protein binding, lipophilicity or, with hydrophilic drugs, a molecular weight of <200Da and weak bases which increase the proportion of ionised drug in the weakly acidic breast milk, leading to ‘trapping’
- Most opioids have a milk-to-maternal plasma ratio of ~2, while NSAIDs have ratios of ~0.1 or below, and paracetamol of 1.
- Generally sedation/drowsiness, respiratory depression
Analgesics:
- Opioids: Small amounts transferred in breast milk, risk of neonatal respiratory depression is very low but can occur (in some case reports)
- If taking post-natally should be observed (mother and neonate) for drowsiness
- Avoid codeine (as per oxford handbook)
- NSAIDs:
- Safe, some caution with aspirin as may cause Reye’s syndrome in neonate
- Paracetamol:
- Considered safe
Antibiotics:
- Penicillins and cephalosporins safe
- Avoid tetracycline, ciprofloxacin, chloramphenicol
Antipsychotics:
- Generally avoid, may cause neonatal drowsiness
Cardiac:
- Avoid amiodarone
- Beta-blockers generally only secreted in small amounts, but sotalol is present in larger amounts
- Avoid ACEi’s, ARB’s, amlodipine
Anticonvulsants:
- Neonatal sedation with phenobarbital and diazepam
Lactation medication database