Judy wonders:

> The next day, our plan for this mom was changed to pumping and dumping
> this milk after 4 hours and then allowing her to save for the rest of
> the day.  I guess the nursing staff was concerned about the amount of
> medication that was in the milk during the 4 hours after taking the
> buspar.
>
> I have read about the concept of amt of med in milk corresponding to amt
> in mothers plasma.  What about the milk produced in the breasts during
> the peak level times?  As the amt in plasma decreases does the amt in
> this milk also decrease?
>
Remember your basic pharmacokinetics and principles of diffusion (molecules
pass from an area of higher concentration to an area of lower concentration)
-- as the levels increase in the plasma (the molecules of the medication that
are not bound to protein) will pass into the milk to equalize the amounts in
the plasma and in the milk.  As the mother metabolizes the drug and it
decreases in the plasma, the drug passes back out of the milk and into the
plasma to keep it equalized -- eventually it is virtually gone out of the
milk.

Your nurses are still visualizing the breast as a bottle.  Whatever gets into
the milk stays there until the mother pumps and dumps.  Remember that pumping
does NOT hasten excretion of the drug - though if the mother is uncomfortable
she can pump for her own comfort or to maintain milk production.  There is no
virtue in "P&D" the milk after four hours -- it's in the plasma and is enough
gone from the milk (if she ever had to wait to begin w/).

Jan Barger, RN, MA, IBCLC
Administrative & Program Director
Lactation Education Consultants
Wheaton, Illinois -- where it is COLD!!!!!

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html