Transfer of Metformin into Human Milk

Hale, Taben M.; Kristensen, J S; Hackett, L.P.; Kohan, Rolland; Ilett, K. F.

doi:10.1007/978-1-4757-4242-8_58

Cited by 40 publications

(68 citation statements)

References 4 publications

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“…The data are in line with those reported in previous studies that measured the excretion of the drug in breast milk over a dosage interval (Hale et al, 2002;Gardiner et al, 2003) or estimated infant exposure based on single time point measurements in women treated with 1000 to 1500 mg of metformin daily (Briggs et al, 2005). More importantly, a daily dose of 2000 mg in our study did not result in greater infant exposure (absolute infant dose of 0.027, 0.036, and 0.050 mg/kg/day) than 1500 mg daily (0.024 mg/ kg/day in our study and the previously described values of 0.023-0.064 mg/kg/day) (Hale et al, 2002). Although the data only represent a small number of women, they suggest a saturable mechanism of metformin transfer across mammary epithelial cells, probably through OCTs (Gardiner et al, 2008).…”

Section: Parametersupporting

confidence: 91%

“…Metformin crosses the placenta readily, and its umbilical cord concentrations at the time of delivery are at least half of the maternal concentrations and in some cases even exceed them (Hague et al, 2003;Vanky et al, 2005;Charles et al, 2006). When metformin is used during breast-feeding, the infant exposure is low, with the estimated relative infant dose reported to be 0.11 to 1.08% of the mother's weight-adjusted dose (Hale et al, 2002;Gardiner et al, 2003;Briggs et al, 2005).…”

mentioning

confidence: 99%

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Pharmacokinetics of Metformin during Pregnancy

Eyal¹,

Easterling²,

Carr³

et al. 2010

Drug Metab Dispos

176

154

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ABSTRACT:Our objective was to evaluate the pharmacokinetics of metformin during pregnancy. Serial blood and urine samples were collected over one steady-state dosing interval in women treated with metformin during early to late pregnancy (n ‫؍‬ 35) and postpartum (n ‫؍‬ 16). Maternal and umbilical cord blood samples were obtained at delivery from 12 women. Metformin concentrations were also determined in breast milk samples obtained over one dosing interval in 6 women. Metformin renal clearance increased significantly in mid (723 ؎ 243 ml/min, P < 0.01) and late pregnancy (625 ؎ 130 ml/min, P < 0.01) compared with postpartum (477 ؎ 132 ml/min). These changes reflected significant increases in creatinine clearance (240 ؎ 70 ml/min, P < 0.01 and 207 ؎ 56 ml/min, P < 0.05 versus 165 ؎ 44 ml/min) and in metformin net secretion clearance (480 ؎ 190 ml/min, P < 0.01 and 419 ؎ 78 ml/min, P < 0.01 versus 313 ؎ 98 ml/min) in mid and late pregnancy versus postpartum, respectively. Metformin concentrations at the time of delivery in umbilical cord plasma ranged between nondetectable (<5 ng/ml) and 1263 ng/ml. The daily infant intake of metformin through breast milk was 0.13 to 0.28 mg, and the relative infant dose was <0.5% of the mother's weight-adjusted dose. Our results indicate that metformin pharmacokinetics are affected by pregnancy-related changes in renal filtration and net tubular transport and can be roughly estimated by the use of creatinine clearance. At the time of delivery, the fetus is exposed to metformin concentrations from negligible to as high as maternal concentrations. In contrast, infant exposure to metformin through the breast milk is low.

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Section: Parametersupporting

confidence: 91%

mentioning

confidence: 99%

Pharmacokinetics of Metformin during Pregnancy

Eyal¹,

Easterling²,

Carr³

et al. 2010

Drug Metab Dispos

176

154

View full text Add to dashboard Cite

show abstract

“…Studies have identified that metformin crossed the placenta but had minimal effect on transplacental flux [22]. The transfer in human milk is minimal and hence can be used safely in lactation [33,34].…”

Section: Biguanidesmentioning

confidence: 99%

“…Hale et al observed that the concentration of metformin in breast milk was low, and the mean exposure to the drug was 0.28 %-much below the 10 % level-which is of concern for breastfeeding. Therefore, it was concluded that the use of metformin is safe for breast feeding [57].…”

Section: Metformin and Insulinmentioning

confidence: 99%

Oral Hypoglycemic Agents in pregnancy: An Update

Kavitha

Kanagasabai

2013

J Obstet Gynecol India

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Introduction Traditionally, insulin has been the gold standard in the management of Type 2 diabetes in pregnancy and gestational diabetes. However, insulin therapy can be inconvenient because of the needs for multiple injections, its associated cost, pain at the injection site, need for refrigeration, and skillful handling of the syringes. This has led to the exploration of oral hypoglycemic agents as an alternative to insulin therapy. Objectives This review examines and evaluates the evidences on the efficacy, safety, and current recommendations of oral hypoglycemic agents. Conclusion The evidence of this study supports the use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes with no increased risk of neonatal hypoglycemia or congenital anomalies. The safety of these oral hypoglycemic agents are limited to the prenatal period and more randomized controlled trials are required to provide information on the long-term follow up on neonatal and cognitive development.

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“…Original data are not published in an available form. Transference of metformin into human milk during lactation is low and considered within safe limits (Hale et al 2002;Gardiner et al 2003).…”

Section: Transplacental Transport Of Metforminmentioning

confidence: 99%

Is Metformin Therapy for Polycystic Ovary Syndrome Safe During Pregnancy?

Brock¹,

Smidt²,

Ovesen

et al. 2005

Basic Clin Pharma Tox

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Polycystic ovary syndrome is characterized among other things by oligo-amenorrhea and may account for more than 75% of cases with anoluvatory infertility. Due to its positive effects on polycystic ovary syndrome-induced infertility metformin has become one of the most common drugs used in this group of patients. The efficacy of the drug as well as the first reports on metformin used in pregnancy has encouraged the continued use of the drug after conception. This MiniReview reviews the current pros and cons of metformin use in pregnancy while awaiting the results of ongoing randomised, controlled clinical trials addressing the subject.

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Transfer of Metformin into Human Milk

Cited by 40 publications

References 4 publications

Pharmacokinetics of Metformin during Pregnancy

Pharmacokinetics of Metformin during Pregnancy

Oral Hypoglycemic Agents in pregnancy: An Update

Is Metformin Therapy for Polycystic Ovary Syndrome Safe During Pregnancy?

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