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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.

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  • Therapeutic issues affecting both mother and child, including time from birth through lactation.

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  • 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 milk.
  • Timing and frequency of feedings and amount of milk ingested by infant important considerations.

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Signs and Symptoms

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  • Refer to individual disorders for diagnostic considerations.

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  • Ensure both maternal and newborn health during months after birth

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  • 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.

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  • For postpartum depression, recommend:
    • Emotional support from family and friends
    • Education about condition
    • Psychotherapy

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  • 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 solubility.
  • Mastitis
    • Usually caused by Staphylococcus aureus, E. coli, and Streptococcus.
    • Treat mother with cloxacillin, dicloxacillin, oxacillin, or cephalexin for 10–14 days.
    • Recommend:
      • Bedrest
      • Adequate oral fluid intake
      • Analgesia
      • Frequent evacuation of breast milk
  • Postpartum depression
    • Sertraline first-line therapy.
    • Paroxetine and nortriptyline second-line treatments.
  • Relactation
    • Metoclopramide 10 mg 3 times daily for 7–14 days recommended pharmacologic therapy. Use only if nondrug therapy ineffective.

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  • Refer to monitoring for individual medical disorders.

Logdson BA. Drug use during lactation. J Am Pharm Assoc (Wash) 1997;NS37(4):407–418.   [PubMed: 9519651] [[XSLOpenURL/ 9519651]]

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