rs1 - k42 - drugs and lactation

8/13/2019 Rs1 - k42 - Drugs and Lactation

1/15

DRUGS AND LACTATION


2/15

Jumlah ibu menyusui makinbertambah, oleh karena itu

obat-obat yan ter!istribusike!alam ASI memba"a masalahkeba!a bayi#

Di USA bebera$a obat

!ikontrain!ikasikan bai ibuyan menyususi se$erti,amtho$trine, %imeti!ine,methima&ole, %y%lo$os$hami!e,

thioura%il !ll# 'ebanyakan obat bisa ter!a$at

!i!alam ASI, teta$i !alam(umlah yan se!ikit# Sebaba hal

ini terantun !ari ka!ar obat


3/15

MENYUSUI ipofise Prolaktin

Jaringan mammaOxytosin ASI


4/15

Kemampuan obat masuk kekompartemen susu

tergantung dari beberapa faktor seperti berat molekul,

kelarutan lipid,, kelarutan dalam air, pengikatan dengan

protein plasma, pKa obat.

Makin kecil berat molekulmakin banyak obat bisa masuk

kedalam ASI, sebaliknya makin besar berat molekul

makin sedikit masuk ke ASI.

Makin banyak obat terikat dengan protein plasma ibu,

makin sedikt obat yang bebas yang bisa masuk kdalam

ASI. kd

Obat masuk kedalam ASI secara difusi pasif
http://neoreviews.aappublications.org/cgi/content/full/neoreviews;5/4/e164/F2


5/15

Tidak semua obat didalam darah ibu bisa masuk

kedalam ASI, hanya obat-obat yang tak terikat pada

protein plasma ibu yang dapat masuk kedalam ASI

alaupun plasma mengandung lipid tetapi tidak

sebanyak yag terdapat dlam ASI yang banyaknya !-

"!# triglyceride, sehingga obat yang telah masuk

kedalam ASI tak bisa kembali ke ibu


6/15

Prolactin

Therapeutic Uses / Preparations:

Causesof Hyperprolactinaemia

)hysioloi%al *$renan%y + $ost-$artum oestroen-stimulate!

.y$othyroi!ism *%ausin TR. e/%ess

*0a%ro$rola%tinaemia )rola%tinoma .y$othalami% !o$amine !e1i%ien%y De1e%ti2e !o$amine !eli2ery La%totro$h %ells insensiti2ity to !o$amine Do$amine antaonists $resent

Treatmentof Hyperprolactinaemia

Corre%tion o1 un!erlyin %ause

Do$amine analoues


7/15

Do$amine AnalouesBromocriptine

3rot $e$ti!e alkaloi!

.ihly sele%ti2e !o$amine re%e$tor aonist#

4eak -a!reneri% an! 5-.T aonist#

Inhibits Gi-$rotein %ou$le! a!enylyl %y%lase

Inhibits $rola%tin release#

Inhibits ro"th hormone release, es$e%ially in G.-se%retin tumour"hi%h %o-se%rete $rola%tin#

Dosage

on%e - three times !aily#

Sa1e in 1irst 6-"eeks o1 $renan%y

Adverse Effects

nausea *stimulation o1 me!ullary 2omitin %entre#

7asos$asm at hih !osae


8/15

Dopamine Analogues

Cabergoline

2ery lon hal1-li1e o1 $rola%tin su$$ression allo"st"i%e-"eekly !osae#

Less ten!en%y than bromo%ri$tine to %ausenausea8 $robably better re%e$tor sele%ti2ity#

Ne"er8 less e/$erien%e in early $renan%y8 no

reason to belie2e a $roblem e/ists#

Lon-term a!2erse e11e%ts unkno"n


9/15

Drus That Stimulatin 0ilk)ro!u%tion

Rememert!e follo"ing commonl# used drugsma#cause $#perprolactinaemia%

Dopamine antagonistAnti&nausea agents' e(g(

meto%lo$rami!e *e## 0a/olon

$ro%hlor$era&ine *Stemetil

!om$eri!one *0otilium

Neuroleptics ) Ma*or tran+uillisers' e(g(

%hlor$roma&ine

tra&o!one

$ro%hlor$era&ine

thiori!a&ine#


10/15

Drus That Inhibit 0ilk)ro!u%tion

9romo%ri$tine

Caberoline

)eroli!e Thia&i!e !iureti%s

The %ombine! oral %ontra%e$ti2e $ill

:uinaoli!e


11/15

Some drugs contraindicated inlactation ,reast&feeding-

9romo%ri$tine

Co%aine

Cy%lo$hos$hami!e

Cy%los$orine Do/orubi%in

Lithium

0ethotre/ate )hen%y%li!ine

)henin!ione Ra!ioa%ti2e io!ine an! other ra!iolable!

elements


12/15

Some drugs contraindicated inlactation ,reast&feeding-

Ci$ro1lo/a%in Chloram$heni%ol Do/e$in

Gol! Cytoto/i% !rus Io!ine-%ontainin %om$oun!s *in%lu!in

to$i%al io!ine

Amio!arone An!roens Dana&ol 3rotamine

La/ati2es


13/15

;a%tors In1luen%in the Trans1er o1Drus 1rom 0other to In1ant in 9reast

0ilk

;a%tors that a11e%t the %on%entrationo1 !ru in the mother

Dru !ose, 1re


14/15

;a%tors that a11e%t trans1er a%rossthe breast 9reast bloo! 1lo"

0etabolism o1 !ru "ithin the breast 0ole%ular "eiht o1 the !ru

Deree o1 ioni&ation o1 the !ru

Solubility o1 the !ru in "ater an! li$i!s

Relati2e bin!in a11inity to $lasma an!milk $rotein

Di11eren%e bet"een the $. o1 maternal$lasma an! milk


15/15

;a%tors that a11e%t !ru%on%entration in the in1ant

Timin o1 1ee!s

;re

rs1 - k42 - drugs and lactation

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