Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Drugline nr 15988

Publicerat 1999-10-15

Question

Is omeprazole a suitable treatment during breast-feeding?

A young woman admitted to the local department of surgery developed an esophagitis (gastroscopically verified). She was breast-feeding her three-month-old infant.

Answer

In rats, omeprazole treatment during late gestation and breast-feeding has led to decreased weight gain in the offspring (1). As the molecular weight of omeprazole is relatively low, it is likely to be excreted into human milk (1). Only one study, however, has been located in which omeprazole was detected in the breast milk: a woman was treated with 20 mg omeprazole per day while breast-feeding. Peak omeprazole concentrations in breast milk (58 nM, three hours after ingestion) were less than seven per cent of the peak serum concentration (950 nM at four hours), indicating minimal secretion, probably because the drug is highly protein-bound in plasma (2). As omeprazole suppresses gastric acid secretion, the possibility of toxic effects in the breast-fed baby will exist, possibly leading to decreased weight gain (1). Further data are needed to define the safety of omeprazole in breast-fed infants. Excretion of cimetidine in breast milk is rather high (milk/plasma ratio 4-12) and cimetidine has not generally been recommended for breast-feeding women (3). However, in the absence of adverse reports, the American Academy of Pediatrics has reclassified the drug as compatible with breast-feeding (1).

Conclusion

Only one study has been located in which omeprazole was detected in the breast milk of a breast- feeding woman. Peak concentration of omeprazole in the breast milk was only seven per cent of the peak serum concentration in the mother.

Further data are needed to define the safety of omeprazole in breast-fed infants.

Cimetidine is a suitable alternative.

Larsen J
Andersen M

References

  1. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 5th edition 1998: 802/o
  2. Marshall JK, Thomson ABR, Armstrong D. Omeprazole for refractory gastroesophageal reflux disease during pregnancy and lactation. Can J Gastroenterology 1998; 12: 225-227 Laegemiddelkataloget 1999 (The Danish Drug Catalogue) 1999: 107

Senast ändrad 2018-09-20