Tag Archives: breastfeeding

Breastfeeding and Drugs: Drugs Deemed Not Safe

Information about what drugs are NOT safe to use during breastfeeding.

A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her breastfeedingphysician to stop nursing.  Of course, if you don’t have to take drugs, whether they are over the counter, or prescription, it is always for the best.

This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacological treatment of breastfeeding mothers.

Below is a list of drugs deemed NOT safe to take by the American Academy of Pediatrics.

Cytotoxic Drugs That May Interfere With Cellular Metabolism of the Nursing Infant:

Cyclophosphamide  — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
Cyclosporine —  Possible immune suppression; unknown effect on growth or association with carcinogenesis
Doxorubicin* — Possible immune suppression; unknown effect on growth or association with carcinogenesis
Methotrexate — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
* Drug is concentrated in human milk.

Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported*

Amphetamine† — Irritability, poor sleeping pattern
Cocaine — Cocaine intoxication: — irritability, vomiting, diarrhea, tremulousness, seizures
Heroin — Tremors, restlessness, vomiting, poor feeding
Marijuana — Only 1 report in literature; no effect mentioned; very long –half-life for some components
Phencyclidine — Potent hallucinogen
* The Committee on Drugs strongly believes that nursing mothers should not ingest drugs of abuse, because they are hazardous to the nursing infant and to the health of the mother.
† Drug is concentrated in human milk.

Radioactive Compounds That Require Temporary Cessation of Breastfeeding*

Copper 64 (64Cu) — Radioactivity in milk present at 50 h
Gallium 67 (67Ga) — Radioactivity in milk present for 2 wk
Indium 111 (111In) — Very small amount present at 20 h
Iodine 123 (123I) — Radioactivity in milk present up to 36 h
Iodine 125 (125I) — Radioactivity in milk present for 12 d 42
Iodine 131 (131I) —  Radioactivity in milk present 2–14 d, depending on study
Iodine131 — If used for treatment of thyroid cancer, high radioactivity may prolong exposure to infant
Radioactive sodium — Radioactivity in milk present 96 h
Technetium 99m (99mTc), 99mTc
macroaggregates, 99mTc O4 — Radioactivity in milk present 15 h to 3 d
* Consult nuclear medicine physician before performing diagnostic study so that radionuclide that has the shortest excretion time in breast milk can be used. Before study, the mother should pump her breast and store enough milk in the freezer for feeding the infant; after study, the mother should pump her breast to maintain milk production but discard all milk pumped for the required time that radioactivity is present in milk. Milk samples can be screened by radiology departments for radioactivity before resumption of nursing.

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*

Anti-anxiety:
Alprazolam
Diazepam
Lorazepam
Midazolam
Perphenazine
Prazepam†
Quazepam
Temazepam
Antidepressants:
Amitriptyline
Amoxapine
Bupropion
Clomipramine
Desipramine
Dothiepin
Doxepin
Fluoxetine — Colic, irritability, feeding and sleep disorders, slow weight gain
Fluvoxamine
Imipramine
Nortriptyline
Paroxetine
Sertraline†
Trazodone
Antipsychotic:
Chlorpromazine — Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores
Chlorprothixene
Clozapine†
Haloperidol — Decline in developmental scores
Mesoridazine
Trifluoperazine
OTHERS:
Amiodarone — Possible hypothyroidism
Chloramphenicol — Possible idiosyncratic bone marrow suppression
Clofazimine — Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation
Lamotrigine —  Potential therapeutic serum concentrations in infant
Metoclopramide† — dopaminergic blocking agent
Metronidazole — In vitro mutagen; may discontinue breastfeeding for 12–24 h to allow excretion of dose when single-dose therapy given to mother
Tinidazole  — See metronidazole
* Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.
† Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.

Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers With Caution*

Acebutolol — Hypotension; bradycardia; tachypnea
5-Aminosalicylic acid — Diarrhea (1 case) ,  Aspirin; Reye’s Syndrome
Atenolol — Cyanosis; bradycardia
Bromocriptine — Suppresses lactation; may be hazardous to the mother
Aspirin — (salicylates) Metabolic acidosis (1 case),  Reye’s Syndrome
Clemastine — Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness (1 case)
Ergotamine — Vomiting, diarrhea, convulsions (doses used in migraine medications)
Lithium — One-third to one-half therapeutic blood concentration in infants
Phenindione — Anticoagulant: increased prothrombin and partial thromboplastin time in 1 infant; not used in United States
Phenobarbital — Sedation; infantile spasms after weaning from milk containing phenobarbital, methemoglobinemia (1 case)
Primidone — Sedation, feeding problems
Sulfasalazine (salicylazosulfapyridine) — Bloody diarrhea (1 case), Reye’s Syndrome
* Blood concentration in the infant may be of clinical importance

 

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Triclosan And Your Child’s Well-being

A hand sanitizer, or antiseptic,  is often used as an alternative to hand washing when soap and water is not readily available. But not all hand sanitizers are created equal, and some may even cause health issues in children and adults.

Practicing good hand hygiene is especially important:wash_hands

After using the bathroom
Before eating or drinking anything
Before and after handling raw foods, fish, poultry, or eggs
After using a public phone
After riding public transportation
In schools and day care centers
After changing diapers
When one is sick
After shaking hands
After sneezing or coughing
After touching an ATM, elevator buttons or escalator handrails

Manufactures claim that sanitizers kill 99.9 percent of germs. But some studies suggest that keeping environments too clean and the persistent use of antibacterial soaps and hand sanitizers may inhibit proper immune system development in children. This is because inflammatory systems require the exposure to common germs to properly develop.

Although the FDA recommends, that when possible, it is better to use soap and water and scrub for at least 20 seconds, that is not always possible in the real world.

So what about hand sanitizers, and can they be dangerous?

There are new studies just out that are claiming that one ingredient used by some manufactures can indeed cause health issues. The ingredient is Triclosan.

Triclosan was first registered as a pesticide in 1969.

Triclosan is an antimicrobial active ingredient contained in a variety of products where it acts to slow or stop the growth of bacteria, fungi, and mildew. It is used in items such as conveyor belts, fire hoses, dye bath vats, or ice-making equipment as an antimicrobial pesticide.

brushteeth2Triclosan is also used in products such as, fabrics, vinyl, plastics (toys, toothbrushes), adhesives, polyethylene, polyurethane, polypropylene, floor wax emulsions, textiles (footwear, clothing), caulking compounds, sealants, rubber, carpeting, and a wide variety of other products.

Triclosan has been used since 1972, and it is present in soaps (0.10-1.00%), deodorants, toothpastes, mouth washes, and cleaning supplies, and is infused in an increasing number of consumer products such as kitchen utensils, toys, bedding, socks, and trash bags.bathing

So your morning routine may start with bathing or showering with soap, brushing your teeth with toothpaste and using mouth wash, perhaps applying some cosmetics, and a dash of deodorant. Then throughout the day, to protect yourself from germs, you use a pocket hand sanitizer, or spray.

Have you checked those items for Triclosan? If the product contains Triclosan, it must be labled.

ingredient_tricolsanSeveral scientific studies have come out since the last time the FDA reviewed Triclosan that warrant further review. According to one recent study, Triclosan may impact respiratory health, by promoting the development of allergies and causing inflammation in the mucous lining of the nose, also known as rhinitis.

Researchers from NIEHS, Norway, and the CDC found the link after measuring levels of Triclosan in urine samples from Norwegian children. The authors published their paper online Nov. 12 in the journal Allergy, and state their findings replicate those of another study that used American children participating in the National Health and Nutrition Examination Survey. Since these reports found an association between Triclosan and the occurrence of allergic sensitization in two different populations, the researchers feel confident the relationship is genuine.

The 623 Norwegian children used in the study have been followed since birth. At age 10, the youngsters received two days of extensive clinical evaluation at Oslo University Hospital, undergoing allergy skin prick tests and lung function assessments on a treadmill, and provided urine and blood samples. The research team sent the urine samples to the Centers for Disease Control and Prevention to measure the amounts of Triclosan.

The results showed that children with allergy sensitivity and rhinitis had the highest levels of Triclosan in their urine. Since Triclosan doesn’t stay in the body very long, 1-2 days according to the study, they think the elevated levels come from continued use of certain products.

Animal studies have shown that Triclosan alters hormone regulation. Other studies in bacteria have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics.

The authors of the study plan to continue examining the Triclosan-allergy connection. They say other research groups have measured Triclosan in breast milk from Swedish mothers and, since Norwegian mothers tend to breastfeed their babies during the first 4-6 months of life, the study plans to follow up the Swedish findings with a study of Triclosan andbreastfeeding allergy development in Norwegian infants. The research team has already collected urine from the newborns and will follow up as they age.

The FDA has partnered with other Federal Agencies to study the effects of Triclosan on animal and environmental health.

So what to do?

Check the labels for Triclosan on the items you and your children use.

Many hand sanitizers, like the PURELL® brand, do not contain Triclosan. Using alcohol based instant hand sanitizers, when soap and water are not available, is one of the Centers for Disease Control and Prevention’s recommendations.

The Centers for Disease Control and Prevention have recommended the use of alcohol-based hand sanitizers when soap and water are not available and hands are not visibly dirty. The CDC recommends that children in school may use alcohol-based hand rubs as an alternative to handwashing.

The main active ingredient in Purell hand sanitizers is ethyl alcohol, the primary germ-killing agent in most hand-sanitizing agents.

According to the Purell company, one of the major benefits of using ethyl alcohol over other germ killing agents is that bacteria have been unable to create a resistance to ethyl alcohol. That means that regardless of how often you use the handsanitizer_purellproduct, the bacteria continue to die.

Other Ingredients Include:

Isopropyl alcohol is also a germ-killing agent. Although the percentage of isopropyl alcohol is much less than ethyl alcohol, both work together to keep your hands free of the bacteria and viruses that cause infection and disease.

Carbomer is a common ingredient used to make gel-like solutions. The carbomer is added to water in Purell by sifting it in. As the carbomer combines with the water, it creates a non-foaming gel.

Tocopheryl acetate is a form of the fat-soluble vitamin E. It is commonly used in skin products as an antioxidant and moisturizer. Its moisturizing properties can help offset the drying effect that ethyl alcohol can cause to the skin.

Glycerin is another common ingredient in skin products. It works in two ways–as a skin moisturizer that absorbs moisture from the air, and to make Purell easier to spread on the skin.

Propylene glycol is a moisturizer that works similar to glycerin. This ingredient pulls moisture from the air and deposits it into the upper layers of the skin, helping to keep skin from drying out.

Isopropyl myrisate works to thicken the consistency of the Purell gel. It also acts as an emollient to prevent the product from feeling oily.

Purell states that aboratory testing has never shown alcohol-based hand sanitizers like PURELL® to lead to bacterial resistance. “There is no evidence that organisms adapt and become immune to the active ingredient in PURELL® products. Once your hands are rubbed dry after application of PURELL®, the alcohol has evaporated completely. PURELL® leaves no harmful residue. A small bit of emollient (skin conditioning agent) is left on the hands after use to leave your hands feeling soft and refreshed.”

Non-alcohol, or some labeled ‘natural’ sanitizers are not as good. Alcohol-based sanitizers work because alcohol breaks up bacterial proteins and kills them.

In the end, know your ingredients, read labels, and choose wisely.

For those interested in trying Purell, here is a link to a coupon: http://www.purell.com/about-us/purell-coupons-promotions.aspx

Citations:
http://www.epa.gov/oppsrrd1/REDs/factsheets/triclosan_fs.htm;

http://www.epa.gov/endo/

Bertelsen RJ, Longnecker MP, Lovik M, Calafat AM, Carlsen KH, London SJ, Lodrup Carlsen KC. 2012. Triclosan exposure and allergic sensitization in Norwegian children. Allergy; doi:10.1111/all.12058 [Online 12 November 2012]

http://www.niehs.nih.gov/news/newsletter/2012/12/science-allergies/

http://www.livestrong.com/article/68666-purell-hand-sanitizer-ingredients/#ixzz2Ms7zvFfg

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