Dear Friends:
I've been away and on return noted a large number of drug questions. So I
have decided to provide my opinion on them as a group.
Fluoxetine(Prozac)...while most of you know that I do not generally support
the use of Prozac in newborns, particularly those born of mothers who have
already received Prozac while pregnant...I am not absolutely adverse to the
use of Prozac in older babies. How old ? I don't really know, but
certainly infants 4-6 months and older could probably tolerate Prozac quite
adequately assuming the dose is minimal (20 mg/day).
Dostinex(cabergoline):
As you all know, there are times when discontinuing breastfeeding is
required. In the past we used a rather dangerous product called Parlodel.
And today I noted someone using it in a mom for some reason. However,
should this need arise again, I would suggest you review cabergoline
(Dostinex) in my newest book. It is a cousin of Parlodel but is much, much
safer. It very effectively (100%) inhibits lactation early postpartum by
inhibiting Prolactin.
Methylphenidate(Ritalin):
As of now, we have no data on its transfer into human milk. I suspect
small, but perhaps significant quantities might transfer. Ritalin is well
absorbed, has a small molecular weight(233), and is lipophilic, which
accounts for its entering the brain compartment. For these reasons alone,
it is likely to enter milk. Now I don't really know if this is still enough
to produce side effects in an infant, but I would be cautious. Observe for
stimulation and anorexia. If your baby stays awake all night, then you know
the reason.
Ciprofloxacin(Cipro):
The fluoroquinolones are generally contraindicated in pediatric patients,
but only relatively. We still use them in emergency situations such as
cystic fibrosis kids. The only problem with Cipro, is that its milk levels
may be slightly higher than other members of this family. Herein, the only
really dangerous condition, is the possible liklihood of overgrowth of c.
difficle and induction of pseudomembranous colitis (a bloody diarrhea). So
when needed in a breastfeeding mom, suitable choices are norfloxacin or
ofloxacin, whose milk levels are quite low.
Orlistat (Zenical):
The so called 'fat burner' is actually just the opposite. It inhibits
gastrointestinal lipoprotein lipase, thus inhibiting the absorption of
triglycerides (fats). Only 5% of orlistat is bioavailable and the plasma
levels are incredibly low (nanograms only). So I really doubt any would
enter milk. This drug is kind of interesting. Seems it may be useful in
helping individuals with high levels of PCBs and other lipophilic toxins rid
their body of these toxins. ( The toxins exit the body dissolved in the
unabsorbable fat in the gut).
Regards
Tom Hale, Ph.D.
www.perinatalpub.com
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