Hales lookups please...?

I need to go in for an endoscopy due to heartburn that just isn't under
control, or resolving. However, the doctor said I should "just pump and
dump for 24 hours because the medications are known to pass to the baby" and
I said "Uh, this baby doesn't take a bottle" and we sort of stalled. Then I
told her about Hales, and that some drugs may have a much shorter half-life.
So here are the cocktails I can choose between:

Fentanyl + Versed (or valium)

Or

Demerol + Versed (or valium)

Would some kind soul please reply with Hale's recommendations each of
these drugs individually? The GI doctor had never heard of Thomas Hale. I
will provide her with this information as well has his web site, and we'll
decide which drugs to use, or perhaps put this off until Gwendolyn can take
a lot more solids than she takes now (which is none).

--angela

Chotii wrote:

Fentanyl + Versed (or valium)


Demerol + Versed (or valium)


Ok. I'll start with Valium (diazepam). Hale says that the published data on
milk and plasma levels are highly variable and many are poor studies. Acute
use - like a single dose - is not contraindicated; it's an L3. Lorazepam and
midazolam are preferred alternatives, though.

Fentanyl is approved by the AAP for use in BF mothers. The half-life is 2-4
hours and time to peak plasma concentration is 7-8 minutes (intravenous).
It's an L2. "It is apparent that fentanyl transfer to milk under most
clinical conditions is poor and is probably clinically unimportant."

Demerol's also approved by the AAP for use in BF mothers. It's an L2 (L3
early postpartum, which I'm assuming you aren't). Fentanyl is preferred to
Demerol.

Versed is a very short-acting benzodiazepine (as noted above, it's preferred
to Valium). Its half-life is 2-5 hours and time to peak plasma concentration
is 20-50 minutes. In a study of a nursing pair, "midazolam and its
hydroxymetabolite were undetectable [in milk] 4 hours after administration."
Also an L3.

I'd be happy to photocopy and mail the relevant pages to you if your
doctor's going to be difficult about this.


--
tristyn
www.tristyn.net
"i have heard the mermaids singing, each to each.
i do not think that they will sing to me."

Well this isn't Hales and I am sure someone will give you better answers,
but Demerol is given during labor and is classified as a B in my drug book ,
which says that no risk has been associated with infants. Versed is commonly
used for infants and children (and adults of course) for procedures. However
it is listed as a D in my drug book and says that it may cause considerable
risk to the infant. Versed is a nice lala drug and makes you forget what you
have went through. My 11-year-old daughter has had enough Versed to last a
lifetime, however, with no problems at all from it. Fentanyl is an opoid
derivitive and seems from my drug book to be more potent.

I have heartburn and it can be easily taken care of with diet. When really
bad attacks hit, Zantac works wonders. Have you tried diet and medication?
--
Sue (mom to three girls)
I'm Just a Raggedy Ann in a Barbie Doll World.--

Chotii wrote in message
...

I need to go in for an endoscopy due to heartburn that just isn't under
control, or resolving. However, the doctor said I should "just pump and
dump for 24 hours because the medications are known to pass to the baby"
and
I said "Uh, this baby doesn't take a bottle" and we sort of stalled. Then
I
told her about Hales, and that some drugs may have a much shorter
half-life.
So here are the cocktails I can choose between:

Fentanyl + Versed (or valium)

Or

Demerol + Versed (or valium)

Would some kind soul please reply with Hale's recommendations each of
these drugs individually? The GI doctor had never heard of Thomas Hale. I
will provide her with this information as well has his web site, and we'll
decide which drugs to use, or perhaps put this off until Gwendolyn can
take
a lot more solids than she takes now (which is none).

--angela

"iphigenia" wrote in message
...
Chotii wrote:

Fentanyl + Versed (or valium)


Demerol + Versed (or valium)


Ok. I'll start with Valium (diazepam). Hale says that the published data
on
milk and plasma levels are highly variable and many are poor studies.
Acute
use - like a single dose - is not contraindicated; it's an L3. Lorazepam
and
midazolam are preferred alternatives, though.

Fentanyl is approved by the AAP for use in BF mothers. The half-life is
2-4
hours and time to peak plasma concentration is 7-8 minutes (intravenous).
It's an L2. "It is apparent that fentanyl transfer to milk under most
clinical conditions is poor and is probably clinically unimportant."

Demerol's also approved by the AAP for use in BF mothers. It's an L2 (L3
early postpartum, which I'm assuming you aren't). Fentanyl is preferred to
Demerol.

Versed is a very short-acting benzodiazepine (as noted above, it's
preferred
to Valium). Its half-life is 2-5 hours and time to peak plasma
concentration
is 20-50 minutes. In a study of a nursing pair, "midazolam and its
hydroxymetabolite were undetectable [in milk] 4 hours after
administration."
Also an L3.

I'd be happy to photocopy and mail the relevant pages to you if your
doctor's going to be difficult about this.

I don't think she is. She was very interested in hearing about Thomas Hale.
As it is, she's been relying on the PDR, which tells her basically nothing
useful in practical terms. And relying on LC's who also probably look in the
PDR. I think I'd be absolutely fine using the Fentanyl/Versed combination.
Nurse the kiddo directly before going into the procedure, and she ought to
be fine for about 4 hours.

--angela

"Chotii" wrote in message . ..
I need to go in for an endoscopy due to heartburn that just isn't under
control, or resolving. However, the doctor said I should "just pump and
dump for 24 hours because the medications are known to pass to the baby" and
I said "Uh, this baby doesn't take a bottle" and we sort of stalled. Then I
told her about Hales, and that some drugs may have a much shorter half-life.
So here are the cocktails I can choose between:

Fentanyl + Versed (or valium)


Hey Angela. I had an endoscopy last week using Fentanyl and Versed for
the conscious sedation. My pede said they are so short acting that one
pump and dump immediately after the procedure was fine.
I nursed Ben at 7AM, was medicated at 8AM, expressed about 6-7 ounces
at 10:30, nursed sometime between 1-2 PM and Ben never showed any
effect. Not even the least bit drowsy or lethargic.

You don't want the valium, you want the Versed. Versed has a half-life
of less than 2 hours, valium has a VERY long half-life something like
40 hours.

If you have any more questions about the meds or the procedure e-mail
me at: k m o m t o 6 @ o p t o n l i n e . n e t

Karen