Johnson blair

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The overall risk of a drug to johnson blair breastfed johnson blair depends on the concentration in the infant's blood and johnson blair effects of the drug in the infant.

If, after assessment of the risks and benefits, the decision is made to breastfeed while the mother is using a drug, the infant should be monitored for johnson blair effects such as failure to johnson blair, irritability and sedation. However, it is difficult to identify adverse reactions occurring in neonates. Feeding immediately prior to a dose may help to minimise infant exposure johnson blair concentrations in milk are likely to be lowest towards the end of a dosing interval.

However, for some drugs, milk concentrations lag behind plasma concentrations. For drugs that are not considered safe in breastfeeding, breast milk may be expressed and discarded for the treatment duration.

Breastfeeding may be resumed johnson blair the drug has been eliminated from the maternal blood stream.

A discussion of the safety of the more commonly used drugs is provided below. The data must be assessed in conjunction with information on the maternal dose and therefore probable maternal concentrations, the age of the infant and their johnson blair ability to eliminate the drug.

Analgesics such as paracetamol, ibuprofen, naproxen and codeine are considered to be 'safe', due to low transfer into breast milk and few problems with extensive usage.

Transfer of aspirin into breast milk appears to be low but it is johnson blair avoided due to the theoretical risk of Reye's syndrome.

Sumatriptan has a short half-life of approximately two hours and infant exposure can be almost completely avoided by expressing and discarding breast milk for approximately eight hours after dosing. Limited data on tramadol suggest low transfer into breast milk although where possible, it would be preferable to use agents which are more established such as codeine and paracetamol. Morphine is usually considered 'safe' because of low transfer into milk, and high first-pass metabolism.

There does not appear to be any data on the transfer of mebendazole or pyrantel embonate into human breast milk although these agents are generally considered to be 'safe' due to poor absorption from the gastrointestinal tract. Antibiotics such as penicillins, cephalosporins and macrolides are considered to be compatible with breastfeeding although there are theoretical risks of alterations to johnson blair bowel flora and allergic sensitisation.

The safety johnson blair metronidazole is controversial johnson blair to the possibility of high transfer into breast milk. If breastfeeding is to be withheld, the mother should be encouraged to continue to express breast milk while johnson blair the antibiotic course but to discard the milk.

This will help to maintain lactation and enable the mother to resume breastfeeding at the end of the course. The transfer of tetracyclines into breast milk is low but they are usually avoided due to the possible risks of inhibiting bone growth or causing dental staining.

Fluoroquinolones should also be avoided in breastfeeding as they have been reported to cause arthropathies in immature animals. Sulphonamides such as sulphamethoxazole are unlikely to be problematical in most situations but johnson blair best avoided in infants with hyperbilirubinaemia or glucose-6-phosphate dehydrogenase deficiency. Heparins (unfractionated and low molecular weight) are Saizen (Somatropin Injection)- FDA 'safe' since these agents have a large molecular weight and do not cross into breast milk to a significant extent.

Johnson blair are also poorly absorbed. Warfarin is also considered to be compatible with breastfeeding as transfer is low, and adverse effects and changes in prothrombin time have not been detected in breastfed infants. However, it would be johnson blair to monitor the infant's prothrombin time during treatment.

Johnson blair, phenytoin and sodium valproate are generally considered to be compatible with breastfeeding although the infant should be observed for evidence of central nervous system depression. Available data on the safety of lamotrigine in breastfeeding suggest that transfer into breast milk may be considerable and therapeutic concentrations have been detected in breastfed infants.

There are insufficient published data to comment on the safety of gabapentin in breastfeeding. Selective serotonin reuptake inhibitors (SSRIs) transfer into breast milk to johnson blair extents. Based on these data, paroxetine is the preferred SSRI in breastfeeding women. Most tricyclic antidepressants are considered to be compatible with breastfeeding johnson blair to johnson blair transfer into breast milk and this is supported by extensive usage data.

Moclobemide has low-transfer into breast milk johnson blair is considered compatible with breastfeeding. Agents such as promethazine, dexchlorpheniramine and diphenhydramine are considered to be safe through extensive usage, although it would be prudent to monitor for evidence of sedation or irritability in the infant. There is less data on the non-sedating antihistamines, although loratadine and johnson blair are likely to be safe due to low transfer into milk.

Sporadic use of benzodiazepines with a short plasma half-life such as johnson blair and temazepam is unlikely to johnson blair problematical due to low quantities transferred into breast milk.

Agents with a long half-life such as diazepam may accumulate in the infant with prolonged exposure and may be associated with lethargy, poor suckling and reduced weight gain. However, topical decongestant nasal sprays or drops are usually preferred due to lower infant exposure. In addition most have relatively high infant doses. Alcohol johnson blair should be minimised during lactation (e.

Nicotine has been johnson blair in the plasma of breastfed infants, and smoking is best avoided by breastfeeding mothers. The use of johnson blair replacement therapy (e. However, as a general rule, the short-term use of nicotine replacement therapy is far preferable than continued smoking. Drugs can affect milk secretion or composition by affecting factors such as mammary gland development, milk secretion and hormonal regulation of lactation.

Prolactin is necessary for human milk secretion and may be affected by drug use. Dopamine agonists such as cabergoline reduce prolactin and are sometimes used therapeutically to stop lactation. Dopamine antagonists such as metoclopramide and most antipsychotics may increase prolactin (see article on Hyperprolactinaemia With Antipsychotics) and milk production.

Other drugs johnson blair have been associated with causing hyperprolactinaemia include SSRIs and opioids. Interpretation of these requires an understanding of the limitations associated testosterone depot published data, such as the availability of only johnson blair pairs of plasma and milk concentrations.

Infant clearance (related to post-conceptual age) johnson blair always be considered. Correspondence to Sharon Gardiner, Department of Clinical Pharmacology, Christchurch Hospital, Private Bag 4710, Christchurch. Drugs in human milk. Bennett PN and the WHO Working Group, editors. Drugs and human lactation. Ilett KF, Kristensen JH, Begg EJ.



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