Home » Thoughts

Category Archives: Thoughts

If a healthcare professional tells you to stop breastfeeding to take a medication….

I’m going to prescribe drug x but I’m afraid it means you need to stop breastfeeding.

Does this sound familiar. It seems to come up frequently on social media platforms but is it true?

In 2008 I was part of the guideline development group for maternal and infant nutrition PH11 https://www.nice.org.uk/Guidance/PH11. It includes a recommendation on prescribing that: sources other than solely the BNF should be consulted when prescribing for a breastfeeding mother e.g. UKDILAS (https://www.sps.nhs.uk/articles/information-resources-for-advice-on-medicines-and-breastfeeding/)  or LactMed (https://www.sps.nhs.uk/articles/information-resources-for-advice-on-medicines-and-breastfeeding/). To discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. As well as to recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. Finally, to acknowledge that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse.

In 2021 the Medicines Health Regulatory Authority (MHRA) published  The Safer Medicines in Pregnancy and Breastfeeding Consortium information strategy (https://www.gov.uk/government/publications/safer-medicines-in-pregnancy-and-breastfeeding-consortium) . Its aim was to set up a partnership of 16 leading organisations who are working together to improve the health information available to women thinking about becoming pregnant, are pregnant, or are breastfeeding. As part of the output of the consortium the BNF team worked with UKDILAS to present more information on breastfeeding rather than relying on the statement that manufacturers advise drug y is avoided by breastfeeding mothers. So, for example the information on antidepressant drugs now reads “Specialist sources indicate that sertraline and paroxetine are the SSRIs of choice in breast-feeding based on passage into milk, half-life, and published evidence of safety. However, all SSRIs can be used in breast-feeding with caution, and since there are risks with switching an SSRI, it may be more clinically appropriate to continue treatment with an SSRI that has been effective, or restart treatment with an SSRI that has previously been effective. With all SSRIs, infants should be monitored for drowsiness, poor feeding, adequate weight gain, gastro-intestinal disturbances, irritability, and restlessness.”

So, if a healthcare professional tells you that you can’t breastfeed on a drug or need to dump your milk for a period after a procedure maybe that may not be based on the most up to date evidence but based on older beliefs.

Prescribing nearly every drug for a breastfeeding mother needs the professional to take responsibility for the outcomes because the manufacturers are not required to do so unless they have conducted clinical trials. One of the few exceptions is Cimzia ™ (Certolizumab pegol). However, they need only show that they reached a decision that a similarly experienced practitioner might make. Using specialist sources and documenting the information shared with the breastfeeding mother would substantiate this.

I asked a Facebook group what they would say to a practitioner who said they had to stop breastfeeding in order to take a named medication. Their responses were strong and empowered whilst remaining polite. This is so different to when I first became interested in the compatibility of drugs in breastmilk in 1995. Hope this information helps you to reach your own shared decision making about what is right for you and your baby.

Suggested comments.

  • Thank you for that, could you please show me the sources that you have used to come to that conclusion?
  • Have you consulted specialist sources or just the BNF?
  • I appreciate your opinion, but I plan to consult a specialist pharmacist before deciding to interrupt breastfeeding.
  • Thank you for that information. What are the risks of the medication if I continue to breastfeed?
  • Where did you get that information?
  • What is the risk if I don’t take medication?
  • Are you aware of the risks of stopping breastfeeding suddenly to take medication?
  • If I wasn’t breastfeeding, what would you prescribe?
  • Are you aware of the following resources?
  • Please may I ask where you’ve checked that drug’s safety for breastfeeding?
  • What are the possible risks of taking versus not taking? Is there anyone in the pharmacy team that can help? Are there any alternatives? Is there anyone you or I can consult?

Cannabis and Breastfeeding

Cannabis use on a regular basis by breastfeeding mothers concerns me. Cannabis has a long half life (25-57 hours) and it takes 5 times this to be removed from milk. THC crosses the blood brain barrier and it is known to accumulate in body fats. Although it is highly protein bound and subject to first pass metabolism, the milk plasma ratio is 8. We do not know enough about the impact on the developing brain to be sure that the amount passing through breastmilk is safe. Regular use is not recommended in the breastfeeding mother or other members of the family who may expose the baby through passive inhalation.

Breastfeeding and Cannabis factsheet

see also Cannabis and Breastfeeding: What We Know and What We Should Do – LCGB

https://www.nutritionfirstwa.org/wp-content/uploads/2017/11/Laurel-Wilson-Marijuana-and-Breastfeeding-Handout-docx.pdf

Ustekinumab (Stelara ™) and Breastfeeding

Ustekinumab is a disease modifying, biological drug used to treat psoriatic arthritis, plaque psoriasis, Crohns disease, and ulcerative colitis. It is given by sub cutaneous injection.

It has a  molecular weight 149,000, poor oral bioavailability  and milk plasma ratio 0.001 – 0.027

Ustekinumab is a recombinant human monoclonal TNF antibody that binds specifically to TNF- α.

It is likely that any small amounts in milk are destroyed in the baby’s gut. Three studies have shown very low levels in  milk but the babies showed no evidence of increased rates of infection or other effects on physical or mental health.

BNF states that “specialist sources indicate use with caution; negligible amounts present in milk which are likely to be destroyed in the infant’s gastro-intestinal tract. In newborn or premature infants there may be greater intestinal absorption. “

Ustekinumab is compatible with breastfeeding due to poor bio-availability and hence low-level absorption by the infant. It should be avoided in the first few days post partum when the gaps between the cells are wide open to facilitate transfer of immunoglobulins.

If it is used in pregnancy live vaccines should be avoided in the baby – normally rotavirus because immunity may be compromised. If not used in pregnancy when the rotavirus is given, the breastfeeding mother needs to wear gloves for 2 weeks to avoid picking up the live viral fragments shed in faeces. This alert card may be useful to have within the red book to remind professionals.

References

  • Klenske E, Osaba L, Nagore D, Rath T, Neurath MF, Atreya R. Drug Levels in the Maternal Serum, Cord Blood and Breast Milk of a Ustekinumab-Treated Patient with Crohn’s Disease. J Crohns Colitis. 2019;13(2):267-269.
  • Saito J, Kaneko K, Kawasaki H, et al. Ustekinumab during pregnancy and lactation: drug levels in maternal serum, cord blood, breast milk, and infant serum. J Pharm Health Care Sci. 2022;8(1):18.
  • Bar-Gil Shitrit A, Ben-Horin S, Mishael T, et al. Detection of Ustekinumab in Breast Milk of Nursing Mothers With Crohn Disease. Inflamm Bowel Dis. 2021;27(5):742-745
  • https://www.ncbi.nlm.nih.gov/books/NBK500594
  • https://e-lactancia.org/breastfeeding/ustekinumab/product/

Adalimumab (Humira™) and Breastfeeding

Adalimumab is a disease modifying, biological drug used to treat rheumatoid arthritis, psoriatic arthritis, Crohns disease, ulcerative colitis and Hidradenitis suppurativa. It is given by sub cutaneous injection.

It has a  molecular weight 148,000. Poor oral bioavailability  and relative infant dose 0.12% ( well below 10% regarded as compatible).

Adalimumab is a recombinant human monoclonal TNF antibody that binds specifically to TNF- α.

It is likely that any small amounts in milk are destroyed in the baby’s gut. Two infants of women who

took adalimumab 40 mg subcutaneously during lactation were followed until 14.5 and 15 months of

age. No adverse reactions were found in the infant to be attributed to exposure of the drug in breast

milk. Both infants were reported to have met all developmental milestones (Fritzsche 2012).

BNF however states that it should be avoided by breastfeeding mothers because the manufacturer

advises it should be avoided for at least 5 months after last dose. This is not based on evidence.

Adalimumab is compatible with breastfeeding due to poor bio-availability and hence low-level absorption by the infant. It should be avoided in the first few days post partum when the gaps between the cells are wide open to facilitate transfer of immunoglobulins.

If it is used in pregnancy live vaccines should be avoided in the baby – normally rotavirus because immunity may be compromised. If not used in pregnancy when the rotavirus is given, the breastfeeding mother needs to wear gloves for 2 weeks to avoid picking up the live viral fragments shed in faeces. This alert card may be useful to have within the red book to remind professionals.

References

  • Wasan SK, Kane SV. Adalimumab for the treatment of inflammatory bowel disease. Expert
  • Rev Gastroenterol Hepatol. 2011 Dec;5(6):679-84.
  • Fritzsche J, Pilch A, Mury D, Schaefer C, Weber-Schoendorfer C. Infliximab and adalimumab
  • use during breastfeeding. J Clin Gastroenterol 2012;46(8):718-19.
  • https://www.ncbi.nlm.nih.gov/books/NBK501392/
  • https://e-lactancia.org/breastfeeding/adalimumab/product/

A podcast recorded by Emma Pickett

I recently recorded this podcast with Emma and feel very emotional about talking about my journey but think it explains many things

Hope you enjoy and thank you Emma

The menopause and breastfeeding

I’m seeing increasing numbers of questions form mums in the perimenopause who are still breastfeeding. Maybe they delivered later or maybe they have been feeding to term or maybe lots of other reasons. I remember asking for blood tests to check my hormone levels because I just couldn;t think clearly anymore and my memory was poor which wasn;t ideal as I was just becoming an independent pharmacist prescriber! My levels had indeed dropped and I went on to HRT. This may not be everyone’s choice or be suitable for them

I have spent many hours this year looking for guidance on HRT and breastfeeding and failed to find any studies or conclusive data. Everything is anecdotal at the moment but I hope this information helps.

One vital piece of information – please keep checking your breasts for lumps . HRT can slightly increase the risk of breast cancer. If you’ve had breast cancer you’ll usually be advised not to take HRT. The increased risk is low: there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years. The risk increases the longer you take it, and the older you are.

Risk of breast cancer BNF June 2024 https://bnf.nice.org.uk/treatment-summaries/sex-hormones/

All types of systemic (oral or transdermal) HRT treatment increase the risk of breast cancer after 1 year of use. This risk is higher for combined oestrogen-progestogen HRT (particularly for continuous HRT preparations where both oestrogen and progestogen are taken throughout each month) than for oestrogen-only HRT, but is irrespective of the type of oestrogen or progestogen. Longer duration of HRT use (but not the age at which HRT is started) further increases risk.

Although the risk of breast cancer is lower after stopping HRT than it is during current use, the excess risk persists for more than 10 years after stopping compared with women who have never used HRT. Vaginal preparations containing low doses of oestrogen to treat local symptoms are not thought to be associated with an effect on breast cancer risk.

The MHRA advises discussing the updated information on the risk of breast cancer with women who use or are considering starting HRT, at their next routine appointment. 

There are also risks of endometrial cancer, ovarian cancer, thromboembolism, stroke and coronary vascular disease. Please do not use higher than recommended/licensed doses of HRT.

As usual please message me on wendy@breastfeeding-and-medication.co.uk if you have a question

The Menopause And Breastfeeding

There remains no conclusive research on the passage of HRT medication into breastmilk. It appears anecdotally that there is less impact on milk supply from using transdermal preparations than oral medication. There remains the possibility of reduction in lactation due to the oestrogen contact inhibiting prolactin. Anecdotally HRT at standard dose has been used by breastfeeding women without impact on the nursling or supply. There is no research on higher doses or use outside of licence application.

For use of vaginal oestrogen see https://breastfeeding-and-medication.co.uk/fact-sheet/breastfeeding-and-oestrogen-cream-or-pessary

I typed “menopause and breastfeeding” into a well-known search engine and what came up first was “It is most likely that you are suffering from menopausal-like symptoms due to breastfeeding. After childbirth and during breastfeeding, women’s oestrogen levels can drop to lower levels than usual. These low levels of oestrogen can cause symptoms that mimic menopause.”

Whilst in a paper published in 2020 Langton et al found that after studying 100,000 women ages 25 to 42 years in the Nurses’ Health Study II (an analysis funded by the National Institutes of Health) “Women who breastfed their infants exclusively for seven to 12 months may have a significantly lower risk of early menopause than their peers who breastfed their infants for less than a month”.  The study also suggests that pregnancy can reduce the risk of early menopause.”

As many women now give birth later than in the past, due to changes in work and finance, and feed until they and their nursling choose to stop, questions that I have received from mothers exhibiting signs of early menopause have increased substantially. Most women begin the menopause between 45 and 55 years of age.

There is also a group who have experienced premature ovarian failure which may be hereditary. There is a further group who have had their uterus and ovaries removed surgically for a variety of reasons.

Premature ovarian insufficiency (POI)

This affects about one in a hundred women under 40 in the UK. It occurs when the ovaries no longer produce normal amounts of estrogen and therefore may not produce eggs. This means that periods will become irregular or stop altogether, with symptoms of the menopause. Many women have POI without actually realising it. Any mother under the age of 40 and having irregular periods (or if they have even stopped completely) should be talk to their doctor about having further tests. Unlike the normal menopause when the ovaries stop working completely, in POI ovarian function can be intermittent, occasionally resulting in a period, ovulation or even pregnancy. This intermittent return of ovarian function means that 5–10% of women with POI will conceive spontaneously.

Perimenopause

The period leading up to the menopause, when hormone production decreases symptoms may start to be experienced is defined as the perimenopause. The period is rather ill defined and may vary dramatically between women. It usually suggested as beginning with irregular menstruation. There may be changes to flow with periods becoming heavier or lighter. For others it may be defined by mood swings or changes in mental function. Each person has a different awareness of their own bodies. This is the period in which most calls about breastfeeding appear to originate with a request to begin hormone replacement therapy.

Menopause

The menopause is defined as an absence of menstruation for over a year. Not all symptoms will be experienced by all women, we are all different.

Typical menopausal symptoms, include:

  • hot flushes
  • night sweats
  • vaginal dryness and discomfort during sex
  • difficulty sleeping
  • low mood or anxiety
  • reduced sex drive (libido)
  • problems with memory and concentration

Post menopause

This is defined as the remainder of a women’s life which can present with an increased risk of osteoporosis although the risk is lowered in women who have breastfed (https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/maternal-health-research/maternal-health-research-bone-density/).

HRT and Breastfeeding

HRT contains oestrogen and sometimes a progesterone e.g., norethisterone, not that dissimilar to that in the combined oral contraceptive which can be used in breastfeeding. The ethinylestradiol content of COCs range from 20–40 micrograms whilst that in HRT products contain 1 – 2 milligrams of estradiol (there are 1000 micrograms in a milligram).

However, Hale says “Although small amounts of Conjugated estrogens may pass into breastmilk, the effects of estrogens on the infant appear minimal. Early postpartum use of estrogens may reduce volume of milk produced and the protein content, but it is variable and depends on dose and the individual.”

“Conjugated estrogens comprise more than 90% of the total estrogen content of human milk and plasma (McGarrigle) Estriol glucosiduronates were the predominant oestrogen metabolites (63%) in plasma”

His conclusion is that low levels pass into milk confirmed in a query to the InfantRisk forum (https://www.infantrisk.com/forum/forum/medications-and-breastfeeding-mothers/medications-and-mothers-milk/339-hormone-replacement-therapy )

Martindale (39th Ed) states that estradiol has been detected in breastmilk after the use of pessaries containing estradiol 50 or 100mg (Nilsson 1978) and that the American Academy of Pediatrics (2001) considers that it is compatible with breastfeeding

Pharmacokinetics of HRT (Taken from Hale)

Conjugated estrogens:  Milk plasma ratio 0.08, Plasma Protein Binding 98%

References

  • American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89.
  • Chollet, J. A., G. Carter, et al. (2009). “Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis.” Menopause 16(5): 978-983.
  • Hale TW Medications and Mothers Milk online access
  • Langton CR, Whitcomb BW, Purdue-Smithe AC, et al. Association of Parity and Breastfeeding With Risk of Early Natural Menopause. JAMA Netw Open. 2020;3(1): e1919615)
  • Martindale The Complete Drug Reference 39 Ed. Pharmaceutical Press
  • McGarrigle HH, Lachelin GC. Oestrone, oestradiol and oestriol glucosiduronates and sulphates in human puerperal plasma and milk. J Steroid Biochem. 1983May;18(5):607-11.
  • Nilsson S, Nygren KG, Johansson ED. Transfer of estradiol to human milk. Am J Obstet Gynecol. 1978 Nov 15;132(6):653-7

Detox products and Breastfeeding

I am often asked about products, usually herbal, to detox and about breastfeeding afterwards. In general these products contain a combination of herbal laxatives and at least one diuretic . Basically the result is to make you pass more urine and develop diarrhoea to “cleanse” the system and usually to lose weight. There is a large risk that in doing so your milk supply will diminish too.

The data on the safety of the herbs in breastfeeding is often poor. I cannot provide data that these products are either safe to use and feed as normal or that they are unsafe – there is just is not enough data that I would be confident in using. Therefore I cannot help with information. The decision has to be your own or on the recommendation of a qualified herbalist who is willing to take professional responsibility.

Caffeine and Breastfeeding

Several questions have come up recently about caffeine intake and breastfeeding. With spending more time indoors we are probably all drinking more caffeinated beverages.

Most of us drink caffeine in one form or another. Women who drink a significant amount of caffeinated drinks who notice that their babies are jittery and restless, may find reduction in caffeine consumption leads to resolution of symptoms. This does not mean that all breastfeeding women need to restrict their consumption of tea and coffee A baby who appears restless may benefit from lowered caffeine intake by the mother but for the average consumption there is little evidence to support restricting intake. From research maternal consumption below 300 milligrammes a day should not cause issues for breastfed babies.

Extract reproduced from Breastfeeding and Medication 2018 by Jones W (Routledge, London)

See also https://www.e-lactancia.org/breastfeeding/caffeine/product/

Moderate coffee consumption does not produce significant levels of caffeine in plasma or urine of infants, and may be undetectable or below therapeutic levels in the neonatal period. (Blanchard 1992, Fulton 1990, Berlin 1984, Hildebrandt 1983, Bailey 1982, Rivera 1977)

Doses greater than 300 – 500 mg of caffeine daily can cause nervousness, irritability and insomnia in the infant (Santos 2012, Martin 2007, Clement 1989, Rustin 1989), as well as decreased iron levels in breast milk and anemia in the infant (Muñoz 1988). Also has been related to the Raynaud’s phenomenon in the nipple of nursing women. (McGuinness 2013)

One study found no problems in infants whose mothers consumed 500 mg of caffeine daily for 5 days. (Ryu 1985)

There is insufficient evidence on the recommended amount of caffeine during lactation. (McCreedy 2018)

Bowel cleansing before colonoscopy and breastfeeding

Just recently I have been contacted by several mothers who were told that they cant breastfeeding during the 24 hour period of bowel prep prior to a colonoscopy or for 24 hours following the procedure under sedation. This is not supported by research and understanding of the pharmacokinetics of the drugs used. It is also a potential risk in that the mother may develop blocked ducts or mastitis necessitating antibiotics if she is unable to express her milk, or in many cases hasn’t been advised to! Not all babies will drink from a bottle so may become dehydrated. Some babies are allergic to cow’s milk protein and may be compromised by 3 days of artificial formula. Hence this fact sheet on the bowel preparations generally used.

It is acceptable to breastfeed as normal during bowel prep. The mother should drink freely of the allowed clear fluids. Someone may be needed to look after the baby during rapid need to evacuate bowels – unless you have taken these products you cant begin to understand the urgency!

PDF of information available

https://breastfeeding-and-medication.co.uk/wp-content/uploads/2023/08/Moviprep-and-breastfeeding-1.pdf

An increasing number of breastfeeding mothers are having colonoscopies to investigate gut problems. The first stage of a colonoscopy is the use of a strong laxative and 24 hours of a fluid only diet to clear out the gut so that the professionals can see the gut in its entirety completely.

Many mothers worry that not eating for 24 hours will reduce their milk supply. Fasting does drop the supply a small amount for some women but frequent feeds seem to overcome problems. It is important to keep drinking the clear fluids which are allowed in order not to dehydrate.

From experience you may find that you need someone else in the house to take the baby urgently when you have to rush to the toilet – there is no waiting! You may find otherwise that you end up feeding whilst on the loo for practical reasons. The bowel washouts produce considerable urgency

Movicol®

One of the most commonly used laxative agents to clear the gut is Movicol ® otherwise known as polyethylene glycol- electrolyte solution. It is a saline laxative which is not absorbed from the gut but pulls water into the bowel to wash the contents out. Because it is not absorbed from the gut it cannot get into breastmilk and would not affect the baby.

MoviPrep®

This dual sachet product contains macrogol and electrolytes in 2 different sachets, Because it is not absorbed from the gut it cannot get into breastmilk and would not affect the baby.

Plenvu ®

This powder contains macrogol and electrolytes in sachets, Because it is not absorbed from the gut it cannot get into breastmilk and would not affect the baby.

Picolax®

Sodium picosulfate is not absorbed from the gastrointestinal tract, and its active metabolite, which is absorbed, is not detectable in breastmilk. Breastfeeding can continue as normal.

KleanPrep ®

KleanPrep contains  macrogol 3350 , an osmotic laxative with a high molecular weigh and zero oral bioavailabilty. Like Moviprep it  accumulates water into the GI tract, where it acts as a laxative. It would be very unlikely to enter the plasma of the mother, or milk.

Citramag®

The ingredients magnesium carbonate and citric acid will form an osmotic laxative by pulling water into the bowel and stimulating the bowel to evacuate. Poor oral absorption of magnesium make it unlikely that any will be absorbed from milk to affect the breastfed baby.

Senna

Senna is a stimulant laxative. Its key ingredient (anthraquinone), is believed to increase bowel activity due to secretion into the colon. It may produce abdominal cramps. In one study of 23 women who received Senokot none was detectable in their milk.[1] Of 15 mothers reporting loose stools, two infants had loose stools (Werthmann 1973). However, in a randomized, double-blind trial comparing Senokot tablets to placebo, of the women in the study, 126 breastfed their infants and took senna while 155 control mothers breastfed their infants. There was no difference in the percentages of infants in the active and control groups with loose stools or diarrhoea (Shelton 1980). In this study 8 doses were taken. In bowel preparation a single dose only is used.

Werthmann MW Jr, Krees SV. Quantitative excretion of Senokot in human breast milk. Med Ann Dist Columbia. 1973;42:4-5.

Shelton MG. Standardized senna in the management of constipation in the puerperium. A clinical trial. S Afr Med J. 1980;57:78-80.

Phosphate enema (Fleet®)

Sodium phosphate is a saline laxative which sucks water into the lumen of the bowel. Whilst some phosphate may get into the plasma, it is very unlikely to change the levels in milk. The oral bioavailabilty is zero to 20%. Use of phosphate enemas should not require interruption of breastfeeding (LactMed)

Bisacodyl (Dulcolax ®)

Bisacodyl is poorly absorbed from the gut (oral bioavailabilty <5%)  and so reaches low levels in breastmilk. It is a stimulant laxative. Breastfeeding can continue as normal

For information on sedatives  (midazolam, fentanyl, pethidine) used in colonoscopies see separate fact sheet . These also do not preclude normal breastfeeding as soon as the mother is awake and alert.

Bismuth subsalicylate (Pepto Bismol®) and Breastfeeding

Another of the frequently asked questions is the use of Pepto Bismol™ for indigestion or nausea

Pepto Bismol™ is marketed to relieve symptoms of upset stomach and diarrhoea. It’s active ingredient is bismuth subsalicylate, so it is related to aspirin which we avoid during breastfeeding at painkilling doses.

We are unsure if bismuth subsalicylate passes into a mother’s breast milk. Although bismuth salts are poorly absorbed from the maternal GI tract, significant levels of salicylate could be absorbed in theory. There are currently no reports of Reye’s syndrome in babies exposed to bismuth subsalicylate and it is normally only used very short term for stomach upset.

Breastfeeding mothers would be well advised to use alternative products to treat acute diarrhoea E.g. loperamide (Imodium®) if possible. However, In my experience of queries Pepto Bismol may be the only product available late at night and at weekends. The risk of short term use is probably low although this cannot be proved. The decision remains with the mother as to whether she wants to take it. Continuing to breastfeed during a stomach upset transfers antibodies to the baby to offer protection from the bacterial or viral condition.

It is also advertised to treat heartburn and indigestion for which there are many alternative remedies which are safe in breastfeeding, containing aluminium, calcium and magnesium carbonate.

See also https://www.e-lactancia.org/breastfeeding/bismuth-sub-oxysalicylate-2/synonym/

A very small amount of bismuth is absorbed from the gut: ≈ 0.1% (Tora 2020, Chen 2010, Boertz 2009, Dresow 1992, Nwokolo 1990: Bismuth is not absorbed into the systemic circulation of the mother, so it cannot be excreted in breast milk.

Salicylate is well absorbed (Nwokolo 1990), but is excreted in breast milk in negligible amounts, and the infant receives a relative dose of 1% (see Aspirin) and no cases of Reye’s syndrome have been reported after taking bismuth salicylate or other non-acetylated salicylate compounds.

Due to the otherwise minimum risk of Reye’s syndrome and the indiscriminate use of bismuth subsalicylate for treatment of gastroenteritis cannot be justifiable since most of gastroenteritis do not require medication instead a simply adequate hydration, a safer alternative should be desirable while breastfeeding. (Chen 2010, Nice 2000) 

Follow Us

Recent Posts

Categories