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DRUGS AND LACTATION

route. and patient compliance – Clearance rate – Plasma protein binding . frequency.Factors Influencing the Transfer of Drugs from Mother to Infant in Breast Milk • Factors that affect the concentration of drug in the mother – Drug dose.

• Factors that affect transfer across the breast – Breast blood flow – Metabolism of drug within the breast – Molecular weight of the drug – Degree of ionization of the drug – Solubility of the drug in water and lipids – Relative binding affinity to plasma and milk protein – Difference between the pH of maternal plasma and milk .

• Factors that affect drug concentration in the infant – Timing of feeds – Frequency and duration of feeds – Volume of milk consumed – Ability of the infant to metabolize the drug .

Prolactin Therapeutic Uses / Preparations: Causes of Hyperprolactinaemia • • • • • • • • Physiological (pregnancy & post-partum: oestrogen-stimulated) Hypothyroidism (causing TRH excess) (Macroprolactinaemia) Prolactinoma Hypothalamic dopamine deficiency Defective dopamine delivery Lactotroph cells insensitivity to dopamine Dopamine antagonists present Treatment of Hyperprolactinaemia Correction of underlying cause Dopamine analogues .

Drugs That Inhibit Milk Production • • • • • Bromocriptine Cabergoline Thiazide diuretics The combined oral contraceptive pill Ergotamine .

Weak a-adrenergic and 5-HT agonist. • Vasospasm at high dosage • Pulmonary infiltrate in chronic use. Dosage • once .Dopamine Analogues Bromocriptine • • • • • • Ergot peptide alkaloid Highly selective dopamine receptor agonist. . especially in GH-secreting tumours which co-secrete prolactin. Inhibits growth hormone release. • Safe in first 3-weeks of pregnancy Adverse Effects • nausea (stimulation of medullary vomiting centre).three times daily. Inhibits Gi-protein coupled adenylyl cyclase Inhibits prolactin release.

Dopamine Analogues Cabergoline • very long half-life of prolactin suppression allows twiceweekly dosage. probably better receptor selectivity. • Newer. • Long-term adverse effects unknown . no reason to believe a problem exists. • Less tendency than bromocriptine to cause nausea. less experience in early pregnancy.

g.g. metoclopramide (e.Drugs That Stimulating Milk Production Remember the following commonly used drugs may cause Hyperprolactinaemia: • • • • • • • • • • • Dopamine antagonist Anti-nausea agents: e. Maxolon) prochlorperazine (Stemetil) domperidone (Motilium) Neuroleptics / Major tranquillisers e. chlorpromazine trazodone prochlorperazine thioridazine. .g.

Some drugs contraindicated in lactation (breast-feeding) • • • • • • • • Bromocriptine Cocaine Cyclophosphamide Cyclosporine Doxorubicin Lithium Methotrexate Phencyclidine • Phenindione • Radioactive iodine and other radiolabled elements .

Some drugs contraindicated in lactation (breast-feeding) • • • • • • • • • • • Ciprofloxacin Chloramphenicol Doxepin Gold Cytotoxic drugs Iodine-containing compounds (including topical iodine) Amiodarone Androgens Danazol Ergotamine Laxatives .