Pregnancy and Breastfeeding Drug Interactions PDF
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This document discusses drug interactions during pregnancy and breastfeeding, including changes in physiological parameters that affect drug absorption, distribution, metabolism, and excretion. It also covers the transfer of compounds into breast milk, factors influencing drug concentration in milk, and the risk of adverse effects on the baby. The document provides practical points, highlighting the importance of considering the expected benefit to the mother compared to the risk to the fetus, and provides information on drugs safe to take.
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Pregnancy and breastfeeding Changes of enzyme during pregnancy - Timing of the administration become very important. Transporters & execration in breast milk. - The transfer of compounds into milk is linked to the function of transport proteins. - Expression of transporters belong...
Pregnancy and breastfeeding Changes of enzyme during pregnancy - Timing of the administration become very important. Transporters & execration in breast milk. - The transfer of compounds into milk is linked to the function of transport proteins. - Expression of transporters belonging to the ATP-binding cassette (ABC-) and Solute Carrier (SLC-) superfamilies varies with the lactation stages of the mammary gland. - Organic Anion Transporting Polypeptides 1A2 (OATP1A2) and 2B1 (OATP2B1), Organic Cation Transporter 1 (OCT1), Novel Organic Cation Transporter 1 (OCTN1), Concentrative Nucleoside Transporters 1, 2 and 3 (CNT1, CNT2 and CNT3), Peptide Transporter 2 (PEPT2), Sodium- dependent Vitamin C Transporter 2 (SVCT2), Multidrug Resistance-associated Protein 5 (ABCC5) and Breast Cancer Resistance Protein (ABCG2) are highly induced during lactation. - Dosing and route of administration becomes very important due to impact on child. Safe and appropriate use of medicines in pregnancy needs considerable of potential harms. Quality use of medicines & pregnant mothers. Breastfeeding Drugs in breastfeeding - Drugs contraindicated during breastfeeding include anticancer drugs, lithium, oral retinoids, iodine, amiodarone, and gold salts. What aNects the concentration of a drug in milk? - Maternal plasma concentration. o AOected by the drug’s distribution into diOerent tissues. High volume of distribution will contribute a lower maternal plasma concentration and a subsequent lower concentration in milk. - Maternal plasma protein binding. o Unbound drug can diOuse to milk. - Size of the drug molecule. o Large molecules don’t make into milk so much. o E.g. heparins and insulin. - Degree of ionisation. o Drug across membranes is a unionised form. Milk is generally slightly acidic, then the mother’s plasma so it attracts weak organic bases. Those drugs get ionised and trapped in the milk. - Lipid solubility. o Lipid soluble drugs such as citalopram may have co-secretion by dissolution in the fat droplets of milk. - Maternal pharmacogenomics What influences the risk of adverse eNects on baby? - Timing of the dose - Toxicity - Oral bioavailability - Volume of distribution - Relative infant dose - Age of infant. Monoclonal antibody drugs in breastfeeding mothers. - Monoclonal antibodies can be excreted in breastmilk. - Low oral bioavailability in the infant - Harm/benefit consideration for serious health problems in the mother. Medication without harm - Understand that contributing factors to this challenge are multifactorial, so solutions need to be multifaceted. - Shared decision making (a person-centred approach) - Make a list – check it twice (medication reconciliation) - Should this medicine be started (initiation) - Harm vs benefit (monitoring) - Review and de-escalate (deprescribe)
