----- Original Message ----- From: "Luluk Lely Soraya I" <[EMAIL PROTECTED]> > > Ini ada artikel lain utk bahan bacaan. > > --------------------------------- > www.aafp.org > > AAP Updates Statement for Transfer of Drugs and Other Chemicals Into > Breast Milk > > Genevieve Ressel > > Women commonly stop breastfeeding because of medication use and advice > from a physician, according to a report from the American Academy of > Pediatrics (AAP). The AAP states that this advice may not be warranted. > Most drugs likely to be prescribed to a nursing mother should have no > effect on milk supply or on the infant's well being. The report, titled > "The Transfer of Drugs and Other Chemicals into Human Milk," appears in > the September 2001 issue of Pediatrics. It includes discussions of > nicotine, psychotropic drugs, silicone breast implants, and other drug > therapies. > > > TABLE 1 > Drugs with No Reported Signs or Symptoms in Infants or Effects on Lactation > > -------------------------------------------------------------------------- ------ > > Acetaminophen > Acetazolamide > Acitretin* > Acyclovir? > Allopurinol* > Amoxicillin > Antimony* > Atropine > Azapropazone (apazone)* > Aztreonam > B1 (thiamin) > B6 (pyridoxine) > B12 > Baclofen > Bishydroxycoumarin (dicumarol) > Butorphanol > Captopril > Carbamazepine > Carbetocin > Cascara > Cefadroxil > Cefazolin Cefotaxime > Cefoxitin > Cefprozil* > Ceftazidime > Ceftriaxone > Chloroform > Chloroquine > Chlorothiazide > Cimetidine? > Ciprofloxacin > Cisapride > Clindamycin > Clogestone > Codeine > Colchicine* > Cycloserine > Diatrizoate > Digoxin > Diltiazem > Dipyrone > Disopyramide > Domperidone > Dyphylline? > Enalapril* Erythromycin? > Ethambutol > Fentanyl* > Fexofenadine > Flecainide* > Fluconazole > Flufenamic acid > Fluorescein* > Folic acid > Gadopentetic (Gadolinium) > Gentamicin > Gold salts > Halothane > Hydralazine > Hydrochlorothiazide* > Hydroxychloroquine? > Ibuprofen > Iohexol > Iopanoic acid > Interferon-a* > Ivermectin > K1 (vitamin) > Kanamycin Ketoconazole > Ketorolac* > Labetalol > Levonorgestrel* > Levothyroxine > Lidocaine > Loperamide* > Loratadine > Magnesium sulfate > Medroxyprogesterone > Mefenamic acid > Meperidine > Methadone > Methimazole (active metabolite of carbimazole) > Methohexital > Methyldopa > Metoprolol? > Metrizamide > Metrizoate > Mexiletine > Minoxidil Moxalactam > Nadolol? > Naproxen* > Nefopam > Nifedipine* > Norethynodrel > Norsteroids > Noscapine > Ofloxacin > Oxprenolol > Phenylbutazone > Piroxicam > Prednisolone > Prednisone > Procainamide > Progesterone > Propoxyphene > Propranolol > Propylthiouracil > Pseudoephedrine? > Pyridostigmine > Pyrimethamine > Quinidine > Quinine Riboflavin > Rifampin > Scopolamine* > Secobarbital > Senna > Sotalol* > Spironolactone > Streptomycin > Sulbactam > Sumatriptan > Suprofen > Terbutaline > Terfenadine > Thiopental > Ticarcillin > Timolol > Tolmetin > Trimethoprim/ sulfamethoxazole > Triprolidine > Valproic acid > Verapamil > Warfarin > Zolpidem > > -------------------------------------------------------------------------- ------ > > NOTE: It is emphasized that many of the literature citations concern > single case reports a or small series of infants. > *--No mention in the literature of clinical effect on the infant. > > ?--Drug is concentrated in human milk. > > > > > The current AAP statement is intended to update the list of agents > transferred into breast milk and describe possible effects on the infant > or lactation, if any are known (Tables 1 and 2). > > > TABLE 2 > Maternal Medication Having Effects on Infant or Lactation* > > -------------------------------------------------------------------------- ------ > > Drug Reported signs or symptoms > Alcohol (ethanol) With large amounts, drowsiness, diaphoresis, deep > sleep, weakness, decrease in linear growth, abnormal weight gain; maternal > ingestion of 1 g per kg daily decreases milk ejection reflex > Aspirin (salicylates) ? Metabolic acidosis (one case) > Atenolol? Cyanosis; bradycardia > Barbiturate Should be given with caution; blood concentration in the > infant may be of clinical importance > Bendroflumethiazide Suppresses lactation > Bromide Rash, weakness, absence of cry with maternal intake of 5.4 g per day > Caffeine Irritability, poor sleeping pattern, excreted slowly; no effect > with moderate intake of caffeinated beverages (2 to 3 cups per day) > Carbimazole Goiter > Chloral hydrate Sleepiness > Chlorthalidone Excreted slowly > Cisplatin Not found in milk > Contraceptive pill with estrogen/progesterone Rare breast enlargement; > decrease in milk production and protein content (not confirmed in several > studies) > D (vitamin) Follow up infant's serum calcium level if mother receives > pharmacologic doses > Danthron Increased bowel activity > Dapsone Sulfonamide detected in infant's urine > Dexbrompheniramine maleate with d-isoephedrine Crying, poor sleeping > patterns, irritability > Estradiol Withdrawal, vaginal bleeding > Ethosuximide Drug appears in infant serum > Fleroxacin One 400-mg dose given to nursing mothers; infants not given > breast milk for 48 hours > Indomethacin Seizure (one case) > Iodides May affect thyroid activity; see iodine > Iodine Goiter > Iodine (povidone-iodine, e.g., in a vaginal douche) Elevated iodine > levels in breast milk, odor of iodine on infant's skin > Isoniazid Acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity > reported in infants > Lithium? One third to one half therapeutic blood concentration in infants > Methyprylon Drowsiness > Morphine Infant may have measurable blood concentration > Nalidixic acid Hemolysis in infant with glucose-6-phosphate dehydrogenase > (G6PD) deficiency > Nitrofurantoin Hemolysis in infant with G6PD deficiency > Phenobarbital? Sedation; infantile spasms after weaning from milk > containing phenobarbital, methemoglobinemia (one case) > Phenytoin Methemoglobinemia (one case) > Sulfapyridine Caution in infant with jaundice or G6PD deficiency and ill, > stressed, or premature infant > Sulfisoxazole Caution in infant with jaundice or G6PD deficiency and ill, > stressed, or premature infant > Tetracycline Negligible absorption by infant > Theophylline Irritability > Thiouracil Drug not used in the United States > Tolbutamide Possible jaundice > > -------------------------------------------------------------------------- ------ > > *--It is emphasized that many of the literature citations concern single > case reports or small series of infants. > ?--Blood concentration in the infant may be of clinical importance and > should be given to nursing mothers with caution. > > > > > Before prescribing drugs to lactating women, the AAP recommends that the > following should be considered: > > Is drug therapy necessary? If drugs are required, the safest drug should > be chosen. > If there is a possibility of risk to the infant, consideration should be > given to measurement of blood concentrations of the drug in the nursing > infant. > Drug exposure to the nursing infant may be minimized by having the mother > take the medication just after breastfeeding the infant or just before the > infant is ready for a lengthy sleep period. > Physicians who encounter adverse effects in infants who have been > receiving drug-contaminated breast milk are urged to document these events > with the U.S. Food and Drug Administration > (http://www.fda.gov/medwatch/index.html). This report should include the > generic and brand names of the drug, the maternal dose and mode of > administration, the concentration of the drug in milk and maternal and > infant blood in relation to the time of ingestion, the method used for > laboratory identification, the age of the infant, and the adverse effects. > > If a pharmacologic or chemical agent does not appear in the tables, it > does not mean that it is not transferred into breast milk or that it does > not have an effect on the infant; it only indicates that there were no > reports found in the literature. > >
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