Drugline nr 21551

Answer

A thorough literature search, including Medline, Drugline and common pharmacological handbooks as well as personal communication with the manufacturer (1) revealed no information whether disulfiram passes over to breast milk or not.

In one handbook it is concluded that disulfiram probably will pass over to breast milk, since its molecular weight is relatively low (297) (2). The oral absorption of disulfiram is approximately 80 percent (3,4) and it has a high lipid solubility (4). The amount bound to proteins varies in different literature, from 50 percent (4) to 96 percent (3). These pharmacokinetic data further strengthens the possibility that it will be excreted into breast milk.

According to Fass (the Swedish catalogue of approved medical products), disulfiram passes over to breast milk in such amounts that a risk for the child exists even in therapeutic doses (5). However, the manufacturer does not have any basis for this conclusion (1).

Conclusion

Since no data concerning the excretion of disulfiram to breast milk exists, the risk for the child is unknown. The general recommendation would be not to breast-feed. However, alcohol intake by an untreated mother constitutes a well documented risk to the child. Therefore, if the mother in the present case wants to breast-feed, treatment with disulfiram should be continued.

Böttiger Y
Jansson Å

References

1. Personal communication Karin Alstrand, Alpharma AB, Sweden (2004-11-19)
2. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2002
3. Disulfiram. DRUG CONSULTS. DRUGDEX(R) System. Thomson MICROMEDEX, Greenwood Village, Colorado (Edition expires (date)
4. Dollery C Sir, editor. Therapeutic drugs. 2nd ed. Edinburgh: Churchill Livingstone; 1999
5. Fass 2004