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HERO ID
7386784
Reference Type
Journal Article
Subtype
Review
Title
Drugs in lactation
Author(s)
Verstegen, RHJ; Ito, S
Year
2019
Is Peer Reviewed?
1
Journal
Journal of Obstetrics and Gynaecology Research
ISSN:
1341-8076
EISSN:
1447-0756
Volume
45
Issue
3
Page Numbers
522-531
Language
English
PMID
30663176
DOI
10.1111/jog.13899
Web of Science Id
WOS:000460180500003
Abstract
Although most medications can be taken safely during breastfeeding, potential risks of infant toxicity do exist because all medications will be excreted into the breast milk to some extent. The amount of medication excreted in the milk depends mainly on (i) within-drug variation, such as dosing; (ii) between-drug variation including chemical characteristics of the medication; and (iii) host factors, such as maternal pharmacokinetics (PK), including variations of pregnancy-associated changes and their post-partum recovery. Neonatal drug exposure is usually assessed by calculating an expected total infant daily dose through breast milk and comparing it to the normal therapeutic dose. However, clinical PK studies in this population are challenging to conduct. Recently, research methods using population PK analyses and physiologically-based PK modeling and simulation techniques have been recognized as a complementary approach to the conventional PK studies in this field. These efforts are important for rational risk assessment balancing the toxicity risk against the benefits of human milk. Health benefits of lactation for both mother and child are significant and a decision to withhold from this should not be taken lightly. In case limited information is present, additional expertise from pharmacists or clinical pharmacologist with expertise in this area should be sought.
Keywords
lactation/breastfeeding; medication; newborn/infant; pharmacokinetics; risk assessment
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