Source: Ward KE, O’Brien
BM. Pregnancy and Lactation: Therapeutic Considerations. In: DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=7992979.
Accessed June 9, 2012.
- Therapeutic issues affecting both mother and child, including
time from birth through lactation.
- Medications enter breast milk via passive diffusion of
nonionized and non-protein-bound medication.
- Drugs with high molecular weights, lower lipid solubility,
and higher protein binding less likely to cross into breast milk
or transfer more slowly.
- The higher the serum concentration of drug in mother’s
serum, the higher the concentration in breast milk.
- Drugs with longer half-lives maintain higher levels in breast
- Timing and frequency of feedings and amount of milk ingested
by infant important considerations.
- Refer to individual disorders for diagnostic considerations.
- Ensure both maternal and newborn health during months
- Principles for selecting medications during pregnancy:
- Select drugs that have been used safely.
- Eliminate nonessential medication and discourage self-medication.
- Avoid medications known to be harmful.
- For postpartum depression, recommend:
support from family and friends
- Education about condition
- Drug use during lactation
- To reduce risk
to infant from drugs transferred through breast milk, select medications:
- Considered safe for infant
- With shorter half-lives
- More protein bound, with lower bioavailability and lower lipid
- Usually caused by Staphylococcus
aureus, E. coli, and Streptococcus.
- Treat mother with cloxacillin, dicloxacillin, oxacillin, or
cephalexin for 10–14 days.
- Adequate oral fluid intake
- Frequent evacuation of breast milk
- Postpartum depression
- Sertraline first-line
- Paroxetine and nortriptyline second-line treatments.
- Metoclopramide 10 mg 3 times daily
for 7–14 days recommended pharmacologic therapy. Use only
if nondrug therapy ineffective.
- Refer to monitoring for individual medical disorders.
Logdson BA. Drug use during lactation. J
Am Pharm Assoc (Wash)