To  : Pat Bucknell
Re  : Phenobarbital

Phenobarbital in lactating women has been extensively reviewed. In general,  PB
transfers readily into milk,  but the plasma levels generally produced in a
fully-breastfed infant are only about 33% of the moms plasma levels.  As with
most anticonvulsants,  you can continue feeding and just monitor the plasma
level of PB occasionally in the infant.  It will probably take about 2-3 weeks
to produce a steady state level in the infant,  so don't measure the plasma
level too soon.  Observe for sedation and apnea.  If an infant is having
apnea, I would not suggest this medication (watch for SIDS).

--------------


To  : Ruth Wilson
Re  : Nystatin, clotrimazole

There are literally dozens of different formulations of nystatin on the market.
I would be tempted to stick with Squibbs formulation,  but ask your pharmacist
which product they have and use the one with minimal ingredients, stabilizers,
and preservatives.

As for clotrimazole,  I am not a big fan of this product.  Systemic absorption
following vaginal administration is only 3-10% of the dose.  Oral absorption is
apparently poor as well.  However,  approximately 15% of patients receiving
oral lozenges in clinical trails have transient increases in liver enzymes,
suggesting liver toxicity. The manufacturer recommends close monitoring of
liver function in patients.   How this would effect an infants liver is
unknown, but long term usage should be discouraged.  Lotrimin, and Mycelex both
contain clotrimazole.

An interesting product however, is Monistat or miconazole.  It too is an
imidazole antifungal just like most of the others.  It however, is not very
toxic and has poor oral absorption too.   No liver problems yet reported,  it
is used topically, vaginally, and intravenously.  It has even been used
successfully in neonates intravenously.  It is available over the counter as
Monistat 7 in a mineral oil base.  The Monistat Vaginal suppositores are made
in hydrogenated vegetable oil (kind of like Crisco ).

Now hear this...I'm not recommending anyone use this product, just providing
you some info that is interesting...  As is usual,  the manufacturer that it is
not known if it is toxic to a nursing infant,  and caution should be urged.


Tom Hale, Ph.D.
Clinical Pharmacologist