모유수유부의 약물 사용 관동대학교 의과대학 제일병원 한국마더세이프 안현경

젖의 장점

모유 수유의 장점 Mother Reduced risk of fracture/osteoporosis Reduced risk of cancer Emotional Convenience Cost Baby Reduced risk of infection Reduced risk of SIDS Reduced risk of many immune mediated diseases Emotional/Bonding

모유수유율

임신 중 모유수유 계획 율 - 제일병원

의료인의 권유 젖이 모자라서 함몰 유두 젖을 못 빨아서 물 젖이어서 유두가 아파서 기타 37.1% 18.8% 12.1% 10.5% 7.0% 6.1% 8.4% 이승주 등. 소아과 40: 1336 모유 수유 중단 원인

수유 중 약물복용 90% of women: medication in first week postpartum Mothers worry about effect of medication on nursing infant –Non compliance –Weaning –Avoidance of breastfeeding 50% of mothers more reluctant to take a medication while nursing than during pregnancy

수유 중 약물복용 Nearly all drugs pass into human milk Almost all medication appears in small amounts, usually less than 1% of the maternal dose Very few drugs are contraindicated for nursing mothers

Drug Maternal gut and liver Maternal plasma Infant gut Infant plasma Oral bioavailability varies High (>90%) Low (<50%) Acetaminopen Acyclovir Lorazepam Azithromycin Metronidazole Budesonide Minoxidil Sulfasalazine Dilution of all drugs leads to low concentrations in mother’s plasma Only drugs are not protein-bound can pass into milk Drug protein binding High Low Bepridil >99% Bisoprolol 30% Diazepam 99% Cyclophosphamide 13% Diclofenac >99% Ranitidine 15% Propranolol 90% Primidone <20% Oral bioavailiability varies Usually very low levels (often undetectable) Route of drugs from mother to baby via breastmilk

약물 선택 시 고려사항 Diffusion / active transport Plasma level Lipid solubility Drug pH Molecular weight 약제 선택 Protein binding Half life Oral bioavailability Non-dose-related toxicity

Age Body weight Health status 약물 선택 시 고려사항 Dose Route of administration Health status 유아 고려사항모성 고려사항

Avoid unnecessary drug use and limit use of OTC products Assess the benefit/risk ratio for both mother and infant Avoid use of drugs known to cause serious toxicity in adults or children Choose drugs for the mother that have known and established information about their pharmacokinetics and toxicity and have low concentrations in breast milk and low relative infant dose Avoid new drugs if possible Drugs licensed for use in infants do not generally pose a hazard Neonates (esp. premature infants) are at greater risk from exposure to drugs via breast milk Route of administration (minimum amount of drug to the infant) Avoid long-acting preparations Monitor Infants exposed to drugs via breast milk for unusual signs/symptoms 약물 선택 시 일반적인 고려사항

Choose medications :- shortest T 1/2, highest protein binding ability, poorest oral absorption, lowest lipid solubility, well-studied in infants. Avoid feeding the infant at the time of peak concentration of the drug in milk. To minimize drug level in the milk - administer the drug at / immediately after the infant feeds. Avoid long-acting drug. In case of no available alternative, medication is best taken just prior to the longest sleep of the infant. 약물 선택 시 일반적인 고려사항

Infants should be monitored for AE :- feeding, sedation, irritability, rash, etc. For some medications with potential harm, temporary suspension of breastfeeding may be necessary. ( Advice the mother about milk expression & cup feeding instead of bottle feeding to avoid nipple confusion) Withhold breastfeeding temporarily if the drug is only used for a short duration. 약물 선택 시 일반적인 고려사항

LACTATION RISK CATEGORY BY THOMAS W HALE L1 safest L2 safer L3 moderately safe L4 possibly hazardous L5 contraindicated

한국 마더 세이프

Reasons for using the telephone line in breastfeeding women 12.5% 11% 9.6% 7.4%

Drugs prescribed for breastfeeding women

Summary Compatible Drug? Is a compatible Drug available? D/C drug & breastfeed Is therapy Necessary? Monitor nursling Monitor nursling Is there a non-drug Alternative That is compatible? Can therapy be Postponed? If acceptable pursue It & breastfeed Yes No