Hale's look-up: [HB] Drugs and Nursing

[reposted from the homebirth list]

Anyone here know about the following drugs while nursing:

neurontin = gabapentin (bipolar) - an anti convulsant
sonata - not sure of the real name - but it's in the class of 'hypnotics'
Wellbutrin - depression

I looked them up in The Nursing Mother's Companion, and there is little to no
info there. A friend of mine takes all these things (not now, she's pg) and
wants to know of the safety level while nursing. I cannot find good info on the
web, either! La Leche wasn't real helpful....frustrating. So, I thought I'd
ask you all. You're a bunch of well educated women and might have better
resources than I.

[end of reposted message]

Please respond here and I will forward any answers to the list.

Thanks,
Larry

Larry McMahan wrote:
[reposted from the homebirth list]

Anyone here know about the following drugs while nursing:

neurontin = gabapentin (bipolar) - an anti convulsant

"Unlike many anticonvulsants, gabapentin is almost completely renally
excreted without metabolism, it does not induce hepatic enzymes, and is
remarkably well tolerated.. No published reports are available on its
transfer into human milk. However, in preliminary results from two patients
studied in our own laboratories indicate a modest infant dose via milk."
Then there's data from the studies...conclusion: "Using these limited data,
the calculated relative infant doses were approx. 6.0% to 3.1% respectively,
of the weight-adjusted maternal dose. No adverse events were noted in either
of these two infants."

L3 (possibly in part because it's new), theoretic infant dose 1.7 mg/kg/day,
half-life 5-7 hours, time to peak plasma concentration 1-3 hours.

sonata - not sure of the real name - but it's in the class of
'hypnotics'

Sonata (zaleplon) is an L2. "Milk levels decreased rapidly following a peak
at 1.2 hours to less than 3 micrograms/L four hours following
administration." Hale feels that the levels excreted in milk would be
subclinical to the infant. Half-life 1.2 hours.

Wellbutrin - depression


Wellbutrin (bupropion) is an L3. "Following one 100 mg dose in a mother the
milk/plasma ratio ranged from 2.51 to 8.58, clearly suggesting a
concentrating mechanism for this drug in human milk. However, plasma levels
of bupropion (or its metabolites) in the infant were undetectable,
indicating that the dose transferred to the infant was low, and accumulation
in infant plasma apparently did not occur under these conditions (infant was
fed 7.5 to 9.5 hours after dosing). The peak milk bupropion level (0.189
mg/L) occurred two hours after a 100 mg dose. This milk level would provide
0.019% of the maternal dose, a dose that is likely to be clinically
insignificant to a breastfed infant."

It's definitely not the best antidepressant for a nursing mom, but if it's
the one that works, it should be OK. A lot of nursing moms do use it.

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

My psychiatrist is not too crazy about the idea of mood stablizers like
Neurontin in nursing mothers. She is pretty weary of it. However, she is
pretty comfortable with most anti-depressants.

The Sonata is a sleep aid. She could also use Ambien (approved by AAP for
nursing mothers) or Tylenol PM which are safe.

HTH,
Annie
Zach, born 6.19.02

"iphigenia" wrote in message
...
Larry McMahan wrote:
[reposted from the homebirth list]

Anyone here know about the following drugs while nursing:

neurontin = gabapentin (bipolar) - an anti convulsant

"Unlike many anticonvulsants, gabapentin is almost completely renally
excreted without metabolism, it does not induce hepatic enzymes, and is
remarkably well tolerated.. No published reports are available on its
transfer into human milk. However, in preliminary results from two
patients
studied in our own laboratories indicate a modest infant dose via milk."
Then there's data from the studies...conclusion: "Using these limited
data,
the calculated relative infant doses were approx. 6.0% to 3.1%
respectively,
of the weight-adjusted maternal dose. No adverse events were noted in
either
of these two infants."

L3 (possibly in part because it's new), theoretic infant dose 1.7
mg/kg/day,
half-life 5-7 hours, time to peak plasma concentration 1-3 hours.

sonata - not sure of the real name - but it's in the class of
'hypnotics'

Sonata (zaleplon) is an L2. "Milk levels decreased rapidly following a
peak
at 1.2 hours to less than 3 micrograms/L four hours following
administration." Hale feels that the levels excreted in milk would be
subclinical to the infant. Half-life 1.2 hours.

Wellbutrin - depression


Wellbutrin (bupropion) is an L3. "Following one 100 mg dose in a mother
the
milk/plasma ratio ranged from 2.51 to 8.58, clearly suggesting a
concentrating mechanism for this drug in human milk. However, plasma
levels
of bupropion (or its metabolites) in the infant were undetectable,
indicating that the dose transferred to the infant was low, and
accumulation
in infant plasma apparently did not occur under these conditions (infant
was
fed 7.5 to 9.5 hours after dosing). The peak milk bupropion level (0.189
mg/L) occurred two hours after a 100 mg dose. This milk level would
provide
0.019% of the maternal dose, a dose that is likely to be clinically
insignificant to a breastfed infant."

It's definitely not the best antidepressant for a nursing mom, but if it's
the one that works, it should be OK. A lot of nursing moms do use it.

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

Spanannie wrote:
My psychiatrist is not too crazy about the idea of mood stablizers like
Neurontin in nursing mothers. She is pretty weary of it.

*giggle*
I think you mean she's wary.
(typo no doubt)

Dawn, needing a bit of a chuckle....thanks!