To Ruth DeRosa:

        Your question on using Ritalin is interesting.  I assume that the
mom is being treated for attention deficit disorder(ADHD),  and is not using
Ritalin as just a stimulant to stay awake.   Any physician who used this
product as a stimulant,  might loose their license.

Lets assume that the mom needs Ritalin because of learning (attention)
difficulties(ADHD).   Ritalin has a rather short half-life,  that's why it
has to be given quite often in children with this problem.   The average
half-life varies between 1-3 hours  and the duration of clinical effects is
about 6 hours.   If the mom only breastfeeds twice daily,  it is likely that
she could feed her infant...take the medication and then wait 12 hours prior
to feeding again.  This however,  depends on the fact that she uses Ritalin
tablets,   NOT Ritalin extended release formulations.

        Although it is likely that Ritalin enters breast milk,  it is
unlikely that the dosage obtained by the infant after 12 hours would be
clinically significant.  If the infant shows signs of overstimulation,
excitement,  sleeplessness, then she might have to re-evaluate taking this
product.  The only other product used for this syndrome is Cylert(pemoline).
I think pemoline is totally unsuitable for this breastfeeding mom,  since
its half-life is longer(12 hrs),  and it has a high pKa (10.5)  which
strongly suggests ion trapping in milk,  and very low protein binding(50%).

        If she uses Ritalin,  please let me know how it works,  and the
effect on the infant if any.






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T.W. Hale, Ph.D.
Associate Professor of Pediatrics
Texas Tech University School of Medicine

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