Thus, an infant who consumed 240 ml of breast milk with an average tolmetin concentration of 0.075 /Lg/ml theoretically could ingest 18 /Lg of tolmetin. Based on the peak maternal plasma concentration in our patient of 20.99 /Lg/ml and a M:P ratio of 0.0055, an infant who consumed 240 ml of breast milk could ingest -27.7 /Lg of to 1metin. Using either of the previous methods, it is determined that an infant would ingest a relatively small amount of the drug in one feed-Eq. 2 Eq. I AUC~~M :P = Aucg~s.;na where areas under the curve (AUe) from 0-4 h were determined by the trapezoidal rule. The low M:P ratio of 0.0055 for tolmetin is predictable because the drug, a weak acid with a pka of 3.5, is extensively bound to plasma proteins ( -99070 ),'.• has a molecular weight >200, and low lipid solubility.The average concentration of tolmetin in breast milk was calculated to be 0.075 /Lg/ml using the following equation:'
LETTERS
A 53-year-old woman presented with bilateral auricular chondritis which was responsive to high doses of prednisone. After a diagnosis of relapsing polychondritis was confirmed, she was treated with dapsone. Her disease responded well to dapsone 200 mg daily. While on this regimen, she developed a dapsone-induced hemolytic anemia which was successfully managed by a reduction in dosage. The use of dapsone for relapsing polychondritis and dapsone-induced hemolytic anemia are reviewed.
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