Andrea,
I'm sitting here paging through my new 2002 "Medications and Mothers'
Milk" obtained from the bookstore Linda Smith provided for our Ohio LC
Conference.  We got to hear Peter Hartmann talk last night and all day
today!  He is wonderful and so much info he hopefully will be publishing
this year.  We will be changing the things we teach moms based on his and
his students' research.  His power point presentations included
ultrasounds showing the diameter of the milk ducts expanding a LOT during
MER, then going back to their pre-MER size! Wow!!  With his prompting we
could even see the milk fat globules moving toward the nipple. And what
he was showing us was that there really aren't "milk sinus' " as such,
the diameter of the ducts is pretty much the same from right behind the
nipple to way far back.  There isn't any special "storage" area for the
milk up close to the areolar complex.   He also did fat content testing
on the milk of 4 lactating moms present--showing that fat content varies
considerably from mom to mom, and from right breast to left breast on the
SAME mom.  He did the tests on pre- & post-feed milk from each mom.  One
mom's fat content changed from 3% pre-feed to 17% post-feed.  Isn't that
amazing?  Anyway, I digress................

According to Hale:
serzone (abridged by me)
AAP: not reviewed
........................this medication should probably not be used in BF
mothers with young infants, premature infants, infants subject to apnea,
or ohter weakened infants.
Pregnancy Risk Category: C
Lactation Risk Category:  L4
Theoretic Infant Dose:  53.7 (that little "u")g.kg/day
Alternatives"  Sertraline, Paroxetine, Trazedone
Adult Dosage:  150-300 mg BID
T1/2= 1-4 hr
PHL=
PK= 1 hr
MW= 507
Vd= 0.9
M/P= 0.1-0.27
PB= >99%
Oral= 20%
pKa= 606
-------------------------------
nexium (esomeprazole)
AAP:  not reviewed
Esomeprazole is just the L isomer of omeprazole (Prilosec) and is
essentially identical to Prilosec.  See omeprazole for BF
recommendations.

Prilosec
AAP:  not reviewed
Omeprazole is a potent inhibitor of gastric acid secretion.  In a study
of one patient receiving 20 mg omeprazole daily, the maternal serum
concentration was negligible until 90 minutes after ingestion and then
reached 950 nM at 240 min.  The breastmilk concentration of omeprazole
began to rise minimally at 90 minutes after ingestion, but peaked after
180 minutes at only 58 nM, or less than 7% of the highest serum level.
Omeprazole mile levels were essentially flat over 4 hours of observation.

Omeprazole is extremely acid labile with half-life of 10 minutes at pH
values below 4.  Virtually all omeprazole ingested via milk would
probably be destroyed in the stomach of the infant prior to absorption.

Pregnancy Risk Category:  C
Lactation Risk Category:  L2
Theoretic Infant Dose:
Adult Concerns:  headache, diarrhea, elevated liver enzymes
Pediatric Concerns:  none reported via milk in one case
Alternatives:  famotidine, nizatidine
Adult Dosage:  20 mg BID

T1/2= 1hr
PHL=
PK= 0.5-3.5 hr
MW=345
Vd=
M/P=
PB= 95%
Oral= 30-40%
pKa=

Hope this helps,
Pat Bucknell, IBCLC
Avon Lake OH
www.mothershelper.org

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