Ilmu Resep 1

Bagian 5
Muvita Rina Wati, MSc., Apt.
Departemen Farmasetika
Fakultas Farmasi UGM

muvitarinawati@gmail.com/
081.392.101.777
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 Drug Use
During
Lactation

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 Lactation

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1. Most drugs are excreted into breast milk
2. Lipophilic drug are readily excreted also non
plasma protein bound
3. pH of milk = 7,0, slightly acidic
4. Mainly transported by passive diffusion
5. Adverse reaction in fetus due to:
a. Slower elimination
b. Sensitive and idiosyncratic reaction

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 Drug Selection
Topical routes Select agent with:
(intranasal, inhalational,
1. Large molecular
vaginal, and dermal )
weight
Absorption 2. Poor absorption
↓ 3. High protein binding
4. Large volume of
Drug transferred to distribution
infant ↓↓ 5. Low serum
concentrations
6. Short half-life
7. Low lipid solubility.

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 Peak Milk Concentration

1. Predict time to feed

2. Avoid time of peak milk concentration to feed the
infant
3. Do not take an extended/ sustained release drug
4. Feed the infant before taking the drug or after peak
milk concentration
5. Save milk before taking the drug if possible

e.g. Low-molecular-weight drugs with high lipid solubility (e.g., fentanyl) will
peak in about 45 minutes, but the similarly sized cephalexin takes 4 hours to
peak in milk.

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 References

1. WHO document: Breastfeeding and Maternal

Medication
2. Online: The NIH: LactMed database

Printed:
1. Medications and Mothers’ Milk: A Manual of
Lactation Pharmacology (Hale 2014)
2. Drugs in Pregnancy and Lactation: A Reference
Guide to Fetal and Neonatal Risk (Briggs 2014)

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 WHO Document

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 WHO Document

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 Online Database

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 Acetaminophen on LactMed_1

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 Acetaminophen on LactMed_2

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 Acetaminophen on LactMed_3

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 Acetaminophen on LactMed_4

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 Acetaminophen on LactMed_5

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