What antiemetic drugs, to be used in peri- and postoperative nausea, can be recommended to nursing mothers?
Nausea can be treated, more or less successfully, by a number of different drugs, including neuroleptic or dopamine blocking agents like metoclopramide, prochlorperazine, dixyrazine and droperidol, antihistamines like cyclizine, or the new group of serotonin blocking agents like ondansetrone. Questions concerning several of these substances and nursing have previously been answered in Drugline (1-4).
Very little is known concerning the passage of antiemetics to human milk. Specific data has only been found for metochlopramide, which is excreted with a milk to plasma ratio of 2, leading to an estimated exposure to the infant of 6-24 ug/kg/day. This is considerably less than the therapeutic dose of 500 ug/kg/day recommended to children [2, 5]. Metochlopramide has been used to stimulate lactation, as it increases prolactin levels in nursing mothers, but this treatment has been questioned, as the effect on the suckling infant, both with regard to the hormonal and the dopamine blocking effect, is unclear [5, 6].
Ondansetrone is known to pass into the breast milk of rats, and the drug is therefore not recommended in nursing mothers (4, 7).
No information has been found concerning the passage to human breast milk of the other substances mentioned above.
Neuroleptic agents should generally be used carefully in nursing mothers, as their dopamine blocking properties are thought to possibly influence the developing brain of the infant. However, single doses of for example metoclopramide or dixyrazine given to nursing mothers is probably of little concern for the long-term neuronal development of the child.
Ondansetrone, droperidol and dixyrazine have short half-lifes (usually less than five hours) and disposing of the milk throughout the first 24 hours after drug intake will minimize the risk for the suckling infant. Metochlopramide has a half-life of 3-10 hours, whereas cyclizine and prochlorperazine have longer half-lifes of about 20-24 hours [1, 7].
There is no perfectly safe antiemetic drug for nursing mothers as data concerning passage to breast milk and effects on suckling infants are lacking for most of these drugs. However, single doses of metoclopramide or dixyrazine given to nursing mothers is probably of very little harm to the child. Disposing of the milk for 24 hours after intake of drug with a short half-life, like ondansetrone, droperidol and dixyrazine, will also minimize the risk for the child.
Senast ändrad 2018-09-20