DRUGS AND BREASTFEEDING" DRUGS AND LACTATION "

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Drug Transfer into Breast Milk 
 Medications generally enter breast milk via passive diffusion
 Transcellular 
            transverse capillary wall; small non-ionized lipid soluble molecules 
             ionized molecules and small proteins enter basal part of cell from interstitial water 
Intercellular
       avoids alveolar cell entirely - large molecules Ig, cow milk protein. 
 Ionophore 
Active transport

 Factors affecting transfer of drugs into breast milk
  maternal serum drug concentration*
  molecular weight
 degree of protein binding* 
 relative drug lipophilicity
 pKa 
 half-life
 active transport Drug Transfer

Cautions and Contraindicated Drugs 
Caution
 beta-blockers – reports of hypotension, bradycardia
  lithium – significant infant serum concentrations (variable)
 amiodarone
 lamotrigine – decreased metabolism, sig. plasma levels 
 Contraindicated
 Antineoplastics 
 Radioactive isotopes
 Ergotamine

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