To      : Danny G.
Re      : Dicyclomine(Bentyl)


        Dicyclomine is an anticholinergic occasionally used for irritable
bowel syndrome, spastic colon, and mucous colitis.  It is not very
effective and is seldom used for these syndromes.  It belongs to the
anticholinergic family just like atropine.  As such pediatric patients are
quite susceptible and several reports(from manufacturer) clearly indicate
that pediatric apnea has occurred, one in a breastfed infant(12 days old),
and also when the dicyclomine was directly administered to an infant for
colic.  Other reported symptoms in pediatric patients include respiratory
distress, seizures, syncope, asphyxia, pulse rate fluctuations, muscular
hypotonia, and coma.   A few deaths have been reported in infants less than
3 months of age.  Dicyclomine is definitely contraindicated in infants less
than 6 months of age.

        Because dicyclomine is a weak base,  its Milk:plasma ratio is above
2.0.   Its efficacy in treating colic is largely unsubstantiated and its
use is discouraged.

        Although its use in a breastfeeding mom is hard to justify, I have
learned through the years,  it is difficult to second-guess this moms
physician in using it,  particularly since we don't know the circumstances.
But it is one product that a breastfeeding mom should be hesitant in using.



To      : Jo Mihalik
Re      : Radioactive I-131 and TC-99

        This question concerns how long a mom treated with I-131 for
hyperthyroidism should pump and dump.

        The most accurate answer is until the radioactive levels in milk
have reached background levels.  At most this would be about 5 half-lives(
8.1 days X 5 = 40.5 days) or probably less.  The only way to accurately
assess this would be to count the radioactivity in expressed milk using a
gamma detector.  Many good clinical laboratories have these instruments.
Technetium - 99 has a short half-life and would be gone in a few days(3-4).



Tom Hale