If anyone not in New Orleans has a copy of Tom Hale's book and could
look up flexeril for me, I'd be most grateful, as I have not been able
to obtain my own copy yet. The archives have a total of 4 postings on
flexeril, none of which are quotable to a pediatrician for reassurance
for the safety of use while BFing - I need a bona fide reference and
prefer to use Tom's. I believe Flexeril is a Class B drug, but has
little research. (The research, in any case, will probably not be fully
applicable to this mom as fibromyalgia doses are significantly less than
usual acute muscle pain dosages.)

Situation (where I approved of continued BFing): Mom with fibromyalgia
(it is like having arthritis in the muscles) and Hashimoto's disease
(she made antibodies that destroyed her thyroid and takes Synthroid
replacement) called me about the safety of taking flexeril while BFing.
She takes only 20 mg at bedtime (a typical dose for fibro) and was told
it peaks 4-6 hours after the dose, so she "must pump and dump in the
middle of the night" (!) (if you know fibro, this is incredibly
unhelpful and subversive advice!)(subversive to the fibro, I mean, not
to mention the BFing). Baby is #5 (but the first since the fibro
diagnosis), 5 days old, 6#15 BW, slightly jaundiced requiring regular
wakenings for BFing but doing well and gaining already.

I told her I was fairly confident, given her dosing routine, that
flexeril at bedtime was not a problem. Not only will she be taking it
after the last feeding of the evening, but the drug will be quite
diluted by the time the baby nurses again 5 hours later.

The issue about the peak activity of the drug, I thought,  has to do
with its activity *within the target organ* (muscles in this case) and
is probably *not* a peak *blood level*. As I understand the physiology
of drugs in milk, it is during peak blood levels that drugs have the
greatest opportunity to crossover into milk, and even then, the breast
is so protective (usually more so than the placenta) that minimal doses
get through anyway.

Ironically, (clear off the altar of ignorance for this latest
sacrifice), she was allowed to take the flexeril 20 mg throughout her
pregnancy, as it was not considered problematic then (when it was fully
available through the placental blood supply!!!) but told not to BF now
!!!.  To coin a phrase: ARGHHHH!

Private email would be wonderful, whoever is not at ILCA and can look it
up for me (the pediatrician is receptive and willing to know more) -
TIA   :-)
Katharine West, BSN, MPH
Sherman Oaks, CA