To :  Debbie Codding:
Re :  Toradol reducing breast milk.

        In reference to the question that Toradol reduces breast milk
supply.  There is no evidence to this that I have seen.  It is generally
contraindicated prenatally due to an elevated incidence of bleeding.
However,  current studies show that the milk levels are really very low and
will have minimal effects on breastfeeding infants.

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

To      : Judy Eastburn
Re      : Drug interactions between antibiotics

        The question concerns whether an infant on Ceclor  should
breastfeed from a mother on Bactrim.  As far as a true drug interaction,
there is little or no reason why both individuals can't take these two
meds.  I would assume the physician is concerned about neonatal kernicterus
or jaundice which is the only real contraindication in using sulfonamides
in breastfeeding moms.  This is only a consideration when the infant is
less than 30 days old,  certainly not at 7 months. I can see no other good
reason why the mom would have to pump and dump.



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

To      : Jan Aken
Re      : Topical Corticosteroid

        This case concerns whether a mom should use topical corticosteroids
on the nipple and breastfeed.  The primary concern is 1) extended use, and
2) the dose received by the infant.

        Corticosteroids placed topically are absorbed systemically by the
infant.  If they are used only occasionally and sparingly,  they are
probably safe.  However, extended long-term use,  while dabbing on gobs of
the stuff could be dangerous. If mom's physician concurs, you could suggest
a "Low Potency"  Steroid cream that can easily be washed off prior to
nursing,  and use only very small amounts for short intervals.

        Low Potency=  Tridesilon, Hydrocortisone


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


To      : J.Costello
Re      : Anticonvulsants

        This question concerns whether a neonate should breastfeed from a
mom taking anticonvulsants.  I think is quite obvious,  many women on
anticonvulsants have breastfed quite successfully.  Immediately postpartum,
mom's plasma levels of the various drugs should be closely monitored and
the dose changed to maintain them in therapeutic range.  Massive changes in
drug kinetics occur that first few weeks postpartum, so mom needs
monitoring.  If there are questions concerning the infant, just monitor the
infant's blood level as well.  We can easily monitor phenobarb, Tegretol,
Dilantin, and others.  Why this mother was given Tranxene(a benzodiazepine
Valium-like drug) is interesting.  Benzos are generally only used as
anticonvulsants on an acute basis(ER), seldom chronically.  Because most of
the anticonvulsants transfer into milk in relatively low levels, most
infants do not attain very high plasma levels.  Again, simply monitor the
infant for sedation, weakness, and his/her plasma drug level.

Tom Hale





tic mother?  I was a doula for a 25 yr. old
primip who continued to take two anti-seizure drugs and the sedative
tranxene
during her pregnancy on the advice of her drs.  She had a great pregnancy
and
normal (w. a small amount of pit and an epidural) but long, labor and
delivery.  Her daughter (8lbs.9oz.) was latching on well and beginning to
breastfeed comparatively easily when at a day and a half postpartum the mom
was told she must cease breastfeeding immediately because the sedative,
tranxene, she was on, was contraindicated for breastfeeding.  (We won't go
into why she wasn't told this earlier, despite repeated questioning and
telling her drs. she intended to breastfeed.)  After pumping & dumping for
8
days she resumed breastfeeding, again, without much trouble!  At 3 wks.
postpartum the mom had two grand mal seizures during the night and had to
be
taken to the emergency room.  She was immediately put back on the tranxene
and her other meds were increased because, even though she hadn't changed
the
dosages and they were ok during pregnancy, they were now very very low.
Now she is in the process of permanently weaning her baby because she is
totally freaked out and exhausted and scared.  My questions are many:  have
any of you worked with an epileptic mom who successfully breastfed?  What
meds was she on? Why would the levels of her meds be normal during
pregnancy,
and lower postpartum?  Does anyone know of a substitute for tranxene?  Her
drs. now tell her they don't want to begin fooling with other meds when
they
know what works for her.  She doesn't want to have the emotional and
physical
turmoil of going back and forth between breast and abm w. pumping/dumping,
etc.  She also feels she needs to sleep more and not have the stress that
her
particular breastfeeding experience brought. Any advice will be warmly
welcomed.  TIA, Janaki Costello, IBCLC, C.D. CCE. LLLL