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

99.7

68.9

59.0

36.4

14.1 10.2

6.512.7

37.4

46

0.0

20.0

40.0

60.0

80.0

100.0

1970 1982 1985 1988 1997 2000 2002 2005 2007 2009

모유수유율

90%

10%

모유수유계획

분유수유계획

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 variesHigh (>90%) Low (<50%)Acetaminopen Acyclovir Lorazepam AzithromycinMetronidazole Budesonide

Minoxidil Sulfasalazine

Dilution of all drugs leads to low concentrations in mother’s plasma

Only drugs are not protein-bound can pass into milkDrug protein bindingHigh LowBepridil >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

약제선택

• Protein binding

• Half life

• Oral bioavailability

• Non-dose-related toxicity

• Age

• Body weight

• Health status

약물선택시고려사항

• Dose

• Route of administration

• Health status

유아고려사항 모성고려사항

• 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

약물선택시일반적인고려사항

• Choose medications :- shortest T1/2 , 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.

약물선택시일반적인고려사항

• 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.

약물선택시일반적인고려사항

LACTATION RISK CATEGORYBY 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

Hemorrhoid

CV disease

GI disease

Contraception

Hepatitis B

Respiratory disease

Others

Psychotic disease

Nutrition

Breast problem

Dental disease

Pain

Inflamation

Dermatologic disease

Thyroid disease

12.5%11%

9.6%

7.4%

Antihistamine

Regional agents

Miscellaneous

CV agents

Nutritional agents

Natural & Herbal pro

Endocrine agents

Respiratory agentsSystemic antibiotics

CNS agents & Analges

GI drugs

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

YesYes

Yes

No

No

No

No