To : Debbie Codding: Re : Toradol reducing breast milk. In reference to the question that Toradol reduces breast milk supply. There is no evidence to this that I have seen. It is generally contraindicated prenatally due to an elevated incidence of bleeding. However, current studies show that the milk levels are really very low and will have minimal effects on breastfeeding infants. --------------------------------------------- To : Judy Eastburn Re : Drug interactions between antibiotics The question concerns whether an infant on Ceclor should breastfeed from a mother on Bactrim. As far as a true drug interaction, there is little or no reason why both individuals can't take these two meds. I would assume the physician is concerned about neonatal kernicterus or jaundice which is the only real contraindication in using sulfonamides in breastfeeding moms. This is only a consideration when the infant is less than 30 days old, certainly not at 7 months. I can see no other good reason why the mom would have to pump and dump. ------------------------------------------- To : Jan Aken Re : Topical Corticosteroid This case concerns whether a mom should use topical corticosteroids on the nipple and breastfeed. The primary concern is 1) extended use, and 2) the dose received by the infant. Corticosteroids placed topically are absorbed systemically by the infant. If they are used only occasionally and sparingly, they are probably safe. However, extended long-term use, while dabbing on gobs of the stuff could be dangerous. If mom's physician concurs, you could suggest a "Low Potency" Steroid cream that can easily be washed off prior to nursing, and use only very small amounts for short intervals. Low Potency= Tridesilon, Hydrocortisone ------------------------------------------ To : J.Costello Re : Anticonvulsants This question concerns whether a neonate should breastfeed from a mom taking anticonvulsants. I think is quite obvious, many women on anticonvulsants have breastfed quite successfully. Immediately postpartum, mom's plasma levels of the various drugs should be closely monitored and the dose changed to maintain them in therapeutic range. Massive changes in drug kinetics occur that first few weeks postpartum, so mom needs monitoring. If there are questions concerning the infant, just monitor the infant's blood level as well. We can easily monitor phenobarb, Tegretol, Dilantin, and others. Why this mother was given Tranxene(a benzodiazepine Valium-like drug) is interesting. Benzos are generally only used as anticonvulsants on an acute basis(ER), seldom chronically. Because most of the anticonvulsants transfer into milk in relatively low levels, most infants do not attain very high plasma levels. Again, simply monitor the infant for sedation, weakness, and his/her plasma drug level. Tom Hale tic mother? I was a doula for a 25 yr. old primip who continued to take two anti-seizure drugs and the sedative tranxene during her pregnancy on the advice of her drs. She had a great pregnancy and normal (w. a small amount of pit and an epidural) but long, labor and delivery. Her daughter (8lbs.9oz.) was latching on well and beginning to breastfeed comparatively easily when at a day and a half postpartum the mom was told she must cease breastfeeding immediately because the sedative, tranxene, she was on, was contraindicated for breastfeeding. (We won't go into why she wasn't told this earlier, despite repeated questioning and telling her drs. she intended to breastfeed.) After pumping & dumping for 8 days she resumed breastfeeding, again, without much trouble! At 3 wks. postpartum the mom had two grand mal seizures during the night and had to be taken to the emergency room. She was immediately put back on the tranxene and her other meds were increased because, even though she hadn't changed the dosages and they were ok during pregnancy, they were now very very low. Now she is in the process of permanently weaning her baby because she is totally freaked out and exhausted and scared. My questions are many: have any of you worked with an epileptic mom who successfully breastfed? What meds was she on? Why would the levels of her meds be normal during pregnancy, and lower postpartum? Does anyone know of a substitute for tranxene? Her drs. now tell her they don't want to begin fooling with other meds when they know what works for her. She doesn't want to have the emotional and physical turmoil of going back and forth between breast and abm w. pumping/dumping, etc. She also feels she needs to sleep more and not have the stress that her particular breastfeeding experience brought. Any advice will be warmly welcomed. TIA, Janaki Costello, IBCLC, C.D. CCE. LLLL