Drugs transmitted through breast milk

Tyson, Ralph M.; Shrader, Earl A.; Perlman, Henry Harris

doi:10.1016/s0022-3476(38)80133-5

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…A few combined laxatives, containing cascara, are placed in Group 111. Clinical and analytical data indicate that cascara compounds are transmitted through breast milk (190).…”

Section: Gastrointestinal Drugsmentioning

confidence: 99%

Drug use During Pregnancy and Breast‐Feeding: A classification sytem for drug information

Berglund

Flodh

Lundborg

et al. 1984

Acta Obstet Gynecol Scand

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Since 1978 the Swedish catalogue of registered pharmaceutical specialities (FASS) has carried a special section entitled “Pregnancy and breast‐feeding” in each product presentation, intended to form an aid for the prescription of drugs to women during child‐bearing and lactation. After a brief review of transplacental transport and milk secretion, reproduction‐toxicology studies in animals, and methods for clinical evaluation of drugs for use during pregnancy, the classification system is presented. On the basis of available data with regard to effects on early and late stages of pregnancy and labour, all the pharmaceutical specialities concerned are assigned to one of the following pregnancy categories: A, B 1, B 2, B 3, C or D. The letters refer to information based on findings in man, and the figures to information based on animal data. For drugs in categories B 3, C or D any harmful effects observed or likely to occur in man or animals are to be specified. The pregnancy categories are defined as follows: Category A. Drugs which may be assumed to have been used by a large number of pregnant women and women of child‐bearing age, without any form of definite disturbance in the reproductive process having been noted so far, e.g. an increased incidence of malformations or other direct or indirect harmful effects on the fetus. Category B. Drugs which may be assumed to have been used by only a limited number of pregnant women and women of child‐bearing age, without any form of definite disturbance in the reproduction process having been noted so far, e.g. an increased incidence of malformations or other direct or indirect harmful effects on the fetus. Category C. Drugs which by their pharmacological effects have caused, or must be suspected of causing disturbances in the reproduction process that may involve risk to the fetus without being directly teratogenic. Category D. Drugs which have caused an increased incidence of fetal malformations or other permanent damage in man or which on the basis of e.g. reproduction‐toxicology studies must be suspected of doing so. This category comprises drugs with primary teratogenic effects. If the drug also has pharmacological effects that may directly or indirectly have a harmful effect on the fetus, this must also be stated. As experience of effects of drugs in Category B is limited, results of reproduction‐toxicology studies in animals are indicated by allocation to one of three subgroups according to the following definitions: Category B 1. Reproduction‐toxicology studies have not given evidence of an increased incidence of fetal damage or other deleterious effects on the reproduction process. Category B 2. Reproduction‐toxicology studies are inadequate or may be lacking, but available data reveal no evidence of an increased incidence of fetal damage or other deleterious effects on the reproduction process. Category B 3. Reproduction‐toxicology studies have revealed an increased incidence of fetal damage or other deleterious effects on the reproduction process, the significa...

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“…A few combined laxatives, containing cascara, are placed in Group 111. Clinical and analytical data indicate that cascara compounds are transmitted through breast milk (190).…”

Section: Gastrointestinal Drugsmentioning

confidence: 99%

Drug use During Pregnancy and Breast‐Feeding: A classification sytem for drug information

Berglund

Flodh

Lundborg

et al. 1984

Acta Obstet Gynecol Scand

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“…11. Anthraquinone containing laxatives like cascara, aloe and senna may cause purgation in the breast-fed infant if high doses are used (Tyson, Shrader & Perlman, 1937;Shore, 1970).…”

Section: Potential Adverse E F F E C T S Of Drugs Present In Milkmentioning

confidence: 99%

The Excretion of Drugs in Milk: A Survey

Lien¹

1979

J Clin Pharm Ther

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Summary In this review a summary of the literature on the excretion of drugs in milk is reported. Because of the current trend of a return to breast‐feeding and the ever‐increasing number of drugs available, a thorough understanding of the potential hazard of medication to a nursing mother becomes very important for clinical pharmacists and other health professionals in advising their patients. This review focuses on the physiological and physicochemical factors affecting secretion of different types of drugs into milk. A brief discussion of the mechanisms of drug excretion is also given. Both plasma (or serum) and milk levels of various drugs reported in humans are compiled. Because of the variations in dose regimens, experimental conditions, analytical methods, and subject to subject variations, wide ranges of both plasma and milk levels have been observed for many drugs. More uniform data will be needed to allow meaningful analysis of various physicochemical models proposed to account for the milk/plasma ratio of various drugs in human subjects. Potentially adverse effects of various drugs present in human milk are presented.

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“…Saliva contained 25 % of the serum concentration (Z0, 18,28,30). Phenobarbital can pass through the placental barrier and is distributed in the fetal tissues (25) and can also be detected in human milk (31). Fifteen to fourty per cent of the amount given are excreted unchanged in the urine (3 normal subjects, Z7).…”

Section: Phenobarbitalmentioning

confidence: 99%

Aspects of the Pharmacology of Phenytoin (Dilantin®) and Phenobarbital Relevant to their Dosage in the Treatment of Epilepsy

Buchthal

Svensmark

1959

Epilepsia

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SUMMARY AND CONCLUSIONS Findings are reviewed concerning the distribution and fate of phenytoin and pheno‐barbital in animals and in man. The serum concentration of these drugs can be considered an adequate expression of their concentration in the brain and hence of their anticonvulsant effect. The serum level increased approximately linearly with increasing dose, 1 mg/kg phenytoin by mouth giving about 3 μg/ml in the serum and 1 mg/kg phenobarbital giving about 10 μg/ml in the serum. The scatter of the ratio of level to dosage was greater for phenytoin than for phenobarbital. In most of the patients who had taken phenytoin for several years the serum level per mg/kg given was above 3 μg/ml per mg/kg. In the individual patient it may therefore be difficult to predict the serum concentration from the amount given and the determination of serum phenytoin has proved of considerable value for the institution and maintenance of therapy. In patients who were given only phenytoin, clinical and electroencephalographic improvement was not observed with serum concentrations below 10 μg/ml. Convulsions in most patients with severe grand mal epilepsy were controlled or significantly reduced in number when the dosage was adjusted so that the serum concentration was about 15 μg/ml (0.3–0.4 g daily to a 70 kg patient). For patients who were on phenobarbital only no information is available as to the correlation between serum level and anticonvulsant effect. In institutionalized patients who had been given combined phenytoin and phenobarbital medication for years serum levels averaged 18 μg/ml of phenytoin and 20 μg/ml of phenobarbital. In patients who had not previously received phenytoin it took about a week to reach a level of 10–15 μg/ml. The time required for the serum concentration to become at equilibrium increased with increasing dosage. With phenobarbital it took still longer, a level of 20 μg/ml being reached after about 1 month. The rate of fall after withdrawal of the drug was about proportional to the serum concentration, the rate of elimination being 35–55 % for phenytoin and 11–25 % for phenobarbital per 24 h. When a serum level had been attained the maximum variation between two daily doses given by mouth at twelve hour intervals did not exceed 10% for phenytoin and was still less for phenobarbital. Thus the administration of phenytoin more often than twice a day and of phenobarbital more often than once a day is unnecessary. Toxic side‐effects (fatigue and signs of incoordination) were not seen with phenytoin serum concentrations below 14 μg/ml. Half of the patients with phenytoin serum levels of 30 μg/ml showed side‐effects. Gum hyperplasia is not included in this compilation. Its occurrence was not correlated to the phenytoin concentration in saliva. The development of an increased tolerance to phenytoin is indicated by the more frequent occurrence of side‐effects in patients who had been given phenytoin treatment for less than six months as compared with those who had been given a longer treatment. With pheno...

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Drugs transmitted through breast milk

Cited by 10 publications

References 5 publications

Drug use During Pregnancy and Breast‐Feeding: A classification sytem for drug information

Drug use During Pregnancy and Breast‐Feeding: A classification sytem for drug information

The Excretion of Drugs in Milk: A Survey

Aspects of the Pharmacology of Phenytoin (Dilantin®) and Phenobarbital Relevant to their Dosage in the Treatment of Epilepsy

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