Re      : Ergot exposure of a breastfed infant

Although we do not ordinarily like to use ergot alkaloids in breastfeeding
mothers, please remember that methylergonovine levels are almost undetectible
in breastmilk, and the oral bioavailability is poor (< 60%).

Re      : Cyclamate and saccharin use in breastfeeding mothers

As for cyclamate and saccharin in breastfeeding mothers,  we have no data to
construe that these would be detrimental to a breastfed infant.  I would
suggest using aspartame(Nutrasweet) instead however, as it consists of two
normal amino acids(phenylalanine and aspartic acid).  Of course,  aspartame
would be contraindicated in a phenylketonuric infant or adult.


Re      :  Elmiron (Pentosan Polysulfate sodium)

PPS is a synthetic sulfated polysacchareide with heparin-like qualities.  It is
used for a number of syndromes including interstitial cystitis.   No data is
available on its transfer into human milk.

However,  it is a long polymer, somewhat like dextran, with a molecular weight
of 4000 to 6000 daltons.  Although it is administered orally,  its  oral
bioavailability is minimal,  only 3(three) to 40%.  It is less absorbed with
food(milk ?).  It has a plasma half-life of approximately 1 hour following IV
use.  I do not know this for sure,  but I would expect milk levels to be very
low.

The plasma levels following 100 mg IV is about 3-3.5 microgram/ml at 2 hours.
Assumming a theoretical, worst case senario, with a Milk:Plasma ratio of 1.0,
the infant would likely ingest approximately 3.5 mg orally per day,  of which
probably less than 3%-40% would be absorbed. (Please remember, this is only
theoretical as we have no breastmilk data).  Adult side effects include:
thrombocytopenia, prolonged prothrombin times, anemia, peripheral edema,
headache, dizziness, nausea, diarrhea, liver toxicity.


Regards
Tom Hale, Ph.D.