To : Pat Bucknell Re : Phenobarbital Phenobarbital in lactating women has been extensively reviewed. In general, PB transfers readily into milk, but the plasma levels generally produced in a fully-breastfed infant are only about 33% of the moms plasma levels. As with most anticonvulsants, you can continue feeding and just monitor the plasma level of PB occasionally in the infant. It will probably take about 2-3 weeks to produce a steady state level in the infant, so don't measure the plasma level too soon. Observe for sedation and apnea. If an infant is having apnea, I would not suggest this medication (watch for SIDS). -------------- To : Ruth Wilson Re : Nystatin, clotrimazole There are literally dozens of different formulations of nystatin on the market. I would be tempted to stick with Squibbs formulation, but ask your pharmacist which product they have and use the one with minimal ingredients, stabilizers, and preservatives. As for clotrimazole, I am not a big fan of this product. Systemic absorption following vaginal administration is only 3-10% of the dose. Oral absorption is apparently poor as well. However, approximately 15% of patients receiving oral lozenges in clinical trails have transient increases in liver enzymes, suggesting liver toxicity. The manufacturer recommends close monitoring of liver function in patients. How this would effect an infants liver is unknown, but long term usage should be discouraged. Lotrimin, and Mycelex both contain clotrimazole. An interesting product however, is Monistat or miconazole. It too is an imidazole antifungal just like most of the others. It however, is not very toxic and has poor oral absorption too. No liver problems yet reported, it is used topically, vaginally, and intravenously. It has even been used successfully in neonates intravenously. It is available over the counter as Monistat 7 in a mineral oil base. The Monistat Vaginal suppositores are made in hydrogenated vegetable oil (kind of like Crisco ). Now hear this...I'm not recommending anyone use this product, just providing you some info that is interesting... As is usual, the manufacturer that it is not known if it is toxic to a nursing infant, and caution should be urged. Tom Hale, Ph.D. Clinical Pharmacologist