To      : Stephanie Ring
Re      : Amiodarone

        First, as to the use of long-term Lasix.  We know that small but
unreported amounts are probably secreted into human milk.  Lasix is
routinely used in neonatal intensive care units,  but long term exposure
has not been really reported.  I would assume that minimal, probably
non-clinically relevant amounts will pass into the infant.  Suggest that
the mother wait several hours after taking Lasix before feeding.  It has a
92 min. plasma half-life, although the biologic effect is longer.   Observe
the infant for potassium loss, and dehydration.

Amiodarone is another matter.  I see serious problems with the use of this
medication and breastfeeding.  I have enclosed the monograph from my book.


AMIODARONE
Generic  = AMIODARONE
Category = Strong antiarrhythmic agent
Although poorly absorbed by the mother(<50%),  maximum serum levels are
attained after 3-7 hours.   This drug has a very large volume of
distribution, resulting in  accumulation in adipose, liver, spleen and
lung.  High rate of fetal toxicity (10-17%).  Should not be given to
pregnant mother unless critically required.   Significant amounts are
secreted into breastmilk.  One reported case of hypothyroidism in infant
following amiodarone therapy of mother.    Because of  long half-life and
concentration in various organs, amiodarone could  continuously build up to
higher levels in infant.  Milk:plasma ratio (dose=200  mg/day) in one group
of mothers varied from 0.4 to 13.    This product should be used only under
the most extraordinary conditions, and the infant should be closely
monitored.  Continuing lactation while using this product is unwarranted.
AHL= 26-107 days         M/P= 0.4-13     PB= 99.98%
PHL=                     PK = 3-7 hrs.


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

To      : Judy Eastburn
Re      : Prednisone, Indocin, Luvox

The prednisone dose listed(8 mg/day) is no problem for a breastfeeding
infant.  Although Indocin is not be best NSAID in the word for BF mothers,
I do not think it is absolutely contraindicated.  Of the NSAIDS,
indomethacin is the most potent,  and generally has the highest incidence
of untoward effects(GI, CNS).  I doubt that a short course of indomethacin
would cause significant problems in an infant of this age.  However, if the
therapy is extended for a long time(weeks, months)  you might consider an
NSAID that is less toxic.  If not observe the infant for GI distress,
nausea, vomiting, and anemia.  An occasional CBC might be advisable for
both mom and maybe even the infant.

Luvox is a new serotonin reuptake inhibitor similar in many ways to Prozac,
Zoloft, and many of the others.  I'm not a real fan of using these meds
during breastfeeding,  but if one is to be used,  it is my opinion that
Zoloft(sertraline) is the best choice at this time.  We currently have one
paper showing that although sertraline penetrates milk,  the plasma levels
in the infant are undetectible and the infants showed no untoward symptoms.

As per your comment concerning who you can trust,  I agree.  There are as
many opinions as there are drugs.   I must admit,  that prior to becoming
infatuated with drugs and breastfeeding, I too would probably have provided
rather poor information.  You must remember,  whereas most medical
professionals deal with adult or pediatric patients,  once breast milk
enters the picture,  most of them are out of their realm and typically
provide inaccurate information.  After many years as a Clinical
Pharmacologist I've learned that pharmacotherapy in breastfeeding patients
is absolutely unique, and requires individuals such as ourselves(LCs, etc)
with rather unique training to ensure accurate information.

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

To      : Debbie Shinskie
Re      : Floxin

Floxin(ofloxacin) is a fluoroquinolone antibiotic similar to
Cipro(ciprofloxacin).  Heretofore,  we have been very hesitant to expose
infants to this family due to some research data indicating arthropathy in
newborn animals.  Well in the last year,  these drugs have been increasing
used in pediatric patients with special needs.  I am now told that the FDA
is currently ready to approve some pediatric indications for this family of
drugs(particulary cystic fibrosis patients) and I expect more use in
pediatric patients.  I do not think that a week of exposure to this
antibiotic will be necessarily detrimental to a nursing infant as long as
the dose is modest.  Observe for nausea,  bloody diarrhea, and  GI
distress.  The peak occurs at about 2 hours,  try to breastfeed around the
peak.



Tom Hale, Ph.D.