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Subject:
From:
Tom Hale <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 16 Jan 1997 14:54:55 -0600
Content-Type:
text/plain
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To      : Linda V.
Re      : Antiulcer medications

While it is true that Zantac(ranitidine) and Tagamet(cimetidine) have rather
high milk:plasma ratios,  this is a prime example when the absolute amount of
medication transferred to the infant is far far lower than a clinically
relevant dose.

The amount of Zantac and Tagamet reaching the infant is miniscule.  But if the
doctor is hesitant,  i have enclosed monographs below on Pepcid and Axid that
have good kinetics as far as breastfeeding is concerned.  Pepcid is a better
product anyway.

Regards
Tom Hale

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





Famotidine              Fax # 1182

Trade:  Pepcid
Uses:   Reduces gastric acid secretion
AAP:    Not reviewed

Famotidine is a typical Histamine-2 antagonist that reduces stomach acid 
secretion.  In one study of  8 lactating women receiving a 40 mg/day dose,  the
peak concentration in breast milk was 72 µg/L and occurred at 6 hours
post-dose.   The milk:plasma ratios were 0.41, 1.78, and 1.33  at 2, 6, and 24
hours respectively.     These levels are apparently much lower than other
histamine H-2 antagonists (ranitidine, cimetidine) and make it a preferred
choice.

Adverse Effects: Headache, constipation, increased liver enzymes

AHL= 2.5-3.5 hours       M/P= 0.41-1.78
PHL=                     PB  = 17%
PK  = 1-3.5 hours        Oral= 40%

References:
1.      Courtney TP, Shaw  RW, et.al. Excretion of famotidine in breast milk.
Br.J.Clin.Pharmacol. 26:639, 1988.
2.      Echizen H & Ishizaki T:  Clinical pharmacokinetics of famotidine.  Clin
        Pharmacokinet 1991; 21:178-194.

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


Nizatidine              Fax # 1317

Trade:  Axid
Uses:   Reduces gastric acid secretion
AAP:    Not reviewed

Nizatidine is an antisecretory, histamine-2 antagonist that reduces stomach
acid secretion.  In one study of 5 lactating women using a dose of  150 mg,
milk levels of nizatidine were directly proportional to circulating maternal
serum levels,  yet  were very low.  Over a 12 hour period 96 up (less than 0.1%
of dose) was secreted into the milk.   No effects on infants have been
reported.

Adverse Effects: Headache,  GI distress



AHL= 1.5 hours          M/P=
PHL=                    PB  = 35%
PK  = 0.5-3 hours       Oral= 94%

References:
1.      Obermeyer BD, Bergstrom RF, Callaghan JT, et.al. Secretion of
nizatidine into human breast milk after single and multiple doses.
Clin.Pharmacol.Ther. 47:724-30,1990.

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