Question not a debate!

Kate CP - posted on 02/05/2011 ( 36 moms have responded )

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I was recently discharged from the hospital AGAIN (long story) and they gave me dilaudid while I was there. I did pump and dump one time since they gave me the medication but I don't know if I need to wait longer before I can nurse again or not? I got the dilaudid around 9am CST, pumped and dumped 2-3 hours later. I'm also on Augmentin and I'm not entirely sure if that's safe to nurse on, too. Help?

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[deleted account]

I would of asked before I was discharge. it's important when breastfeeding to find out what you can take and safely breastfeed and what you can't. and if in the case you can't find out if there is a "breast feeding safe" alternative

Charlie - posted on 02/06/2011

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The purpose of pumping and dumping while drinking or any other reason ( antibiotics ) is to relive discomfort from engorged breasts often due to increased intake of liquids or lack of breastfeeding .

Ez - posted on 02/06/2011

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Kate watch out for thrush in Paul's mouth (and then your nipples) from the anti-biotics. I was on some heavy duty ABs after I had Milla and she got it. It didn't make her sick, but it is a pain in the ass to get rid of.

Veronica - posted on 02/05/2011

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I always ask the pharmacist - they are the ones that study on medications. I was put on a very strong anti-biotic after one of my children, and my doc said to go ahead and nurse -- when i went to verify it with the pharmacist, she said absolutely not -- I chose to go with the pharmacist - and it was a good thing too - i got migraines and diarrhea from the meds -- i couldnt imagine what my baby would have went through. Even a trace of it.

Cassie - posted on 02/05/2011

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I nursed Emma after having a round of dilauded for kidney stones. My lactation counselor said it was fine. I just noticed that Emma was drowsy after.

36 Comments

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Minnie - posted on 02/07/2011

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Ha!- one thing I'll never defend is LLLI's ability to create a user friendly website...it seems to trickle down to each area too.

Kate CP - posted on 02/07/2011

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I didn't see any email addresses for them, Lisa. But the webpage was a little confusing to navigate for the Texas chapter.

Sarah: Uhh, yea I did. I said I had tried contacting several LLL members and lactation consultants and no one was available. Not entirely sure what all this has to do with formula feeding, however...

Minnie - posted on 02/07/2011

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Kate, did the LLL Leaders have any e-mail addresses? I know I personally have an easier time getting to the e-mail questions. Often we're out or I'm tending to the kids so a call goes to voicemail.



It must have been so insanely frustrating not reaching anyone who could help when you needed it.



But anyways, you've got the info on the drugs and you and Paul appear to be happily nursing away. :)

[deleted account]

kate maybe i don;t know cos im one of those god awful formula mother's but you didn't exactly state that you already previously tried these things

Kate CP - posted on 02/07/2011

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Sarah, it really sounds like you think I didn't try to get this information already. I DID. I waited around at the hospital, I called two OTHER hospitals looking for lactation consultants, I called my local LLL chapter (SEVERAL numbers) and NO ONE answered and NO ONE was available. It's not like I went "Eh, fuck it".

[deleted account]

Kate im surprised the nurses didn't know and if it were me i would of been sitting there complaining until they pulled their fingers out. mind you i know in australia they have a breastfeeding hotline and im pretty sure they would know something

Minnie - posted on 02/07/2011

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I always wonder why those who care for lactating women never have a copy of Hale's Medications and Mother's Milk. Seems like a matter of common sense to me.



I found it odd that I had to educate my surgeon and anesthesiologist when I went in for hernia surgery back in October. They told me I would have to pump and dump for 24 hours (pulled out of their ass) for my toddler.



So out came Hale's plopped onto their desks, chock full of the most current information and research on breastfeeding and medication. Stuns me that an anesthesiologist wouldn't even be aware.

Kate CP - posted on 02/07/2011

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Sarah: I did ask and the nurses didn't know. I was so eager to get the hell out of there that I didn't want to stick around for a lactation consultation that I knew would end up taking all day. They were dragging their feet the entire time I was there. It took two hours to get me a pump when they were supposed to have had orders written for it from when I was admitted. :/

Melissa - posted on 02/06/2011

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what I meant when I said it serves no purpose was that it doesnt remove alcohol from your breast milk but yeah for comfort should be done. I havent had o yet but my wedding day is in 4 weeks and I somehow need to find time to express or breast feed should be interesting

[deleted account]

MANDY: what do you mean pumping and dumping serves no purpose?? i dont drink but i have always heard that! can you educate me please??

Melissa - posted on 02/06/2011

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Im glad your feeling better. I took so many anti biotics that I had left in the cupboard to avoid aving to visit docs constantly while pregnant and I didnt even know that some might not be safe but when I was overdue they gave me some but a small dose for a sinus infection. Glad it all worked out

Kate CP - posted on 02/06/2011

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Well I've been on the Augmentin for two days now and the baby hasn't had any adverse reactions to it. I'm feeling 1000% better and I haven't had to take a pain pill all day. So...I'd say we're doing good so far.

Pumping and dumping with alcoholic drinks is totally different from medications that stay in your body up to 12 hours at a time. Alcohol gets processed very fast whereas other medications like antibiotics and some pain relievers can exist in the blood stream (and thus, in breast milk) for hours and hours. So if I were taking a medication that was absolutely NOT safe to use while nursing I would have to dump my breast milk and not nurse.

Melissa - posted on 02/06/2011

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pumping and dumping serves no purpose with alcohol so Im guessing it doesnt with anti biotics either. Thats the one I used to use but Im pretty sure its not fully safe in pregnancy or breast feeding I think they had to give me something else but could be wrong. Its prob still ok but I think that it was less safe then some others. Either that or something else the doctors said to me it said dont take while feeding. The pharmacy recommend me formula feeding while on anti biotics but I chose to bf still so they said take one straight after a breast feed. Anti biotics can give baby the runs but its never happened for my girl and I had so many courses when she was newborn

Minnie - posted on 02/06/2011

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Interesting, Augmentin -is- an antibiotic.

The best thing to prevent necrotizing entercolitis in premature infants is mother's colostrum, transitional and mature milk.

[deleted account]

In my experience, NEC is Necrotizing Enterocolitis. An infection that gets into babies bowels and causes them to shut down. It happens with preemies (it happened to my son) because they lack an immune system to fight off the infection. If caught soon enought NEC can be treated with antibiotics, severe cases can require surgery to remove parts of the bowel or it can even result in death. I want to stress that I've only ever heard of preemies getting NEC.

Kate CP - posted on 02/06/2011

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What is NEC? Also, according to safefetus.com Augmentin is a category B drug which means it's generally considered safe during pregnancy and breast feeding although ONE report suggested there MAY be a link between augmentin exposure during the first trimester and spina bifida. But, that's neither here nor there since I'm not pregnant.

I also desperately need the drugs or I will die. Yes, I will die. I have an immune disorder and I cannot NOT take my antibiotics.

Erin: Yes, I'll be downing the yogurt like crazy while I'm taking the pills.

[deleted account]

As a general rule 1% of any drug will get into the breast milk... If u don't desperately need them avoid all drugs in pregnancy and lactation.,, augmentin not ok in pregnancy as causes NEC.

Minnie - posted on 02/05/2011

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I'm so happy that you and Paul are once again enjoying yourselves :). It definitely can be concerning when taking a strong medication and thinking about what it might be doing to such a wee little one. What a great momma you are, looking out for him!

[deleted account]

Yea i broke my finger once and took Vicodin and they gave me lareltabs and and asked the and the doctor said the same thing that only a very very small amount if any it gets to your baby thru breastmilk.

Kate CP - posted on 02/05/2011

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I love you, Lisa. :)

I tried contacting several members of My local LLL chapter and no one was available or answered the phone. And then the lactation consultants at the hospitals are all gone for the weekend I guess. :/

I just nursed the little bug and he was so happy to have Mommy's breast back. Apparently my mom said he was NOT happy with the bottle (I had managed to hand express about 2 oz at home before I went to the hospital and while at the hospital I got to pump 4 more oz before they gave me anything) but he took it pretty well. Right now he's napping and happy. Thanks for the input, ladies! You're all life savers. :)

Minnie - posted on 02/05/2011

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Kate, the FDA considers a drug effectively eliminated from the body after 5 times the half life has passed. For hydromorphone the half life is 11.1 hours, so you're looking at a looooooong time if you want to pump and dump until that stuff is gone.



For augmentin the half life is 1.7 hours.



Remember that with both drugs, the amount your baby is receiving through your milk is significantly less than what your baby would receive orally if it was prescribed to him.

Minnie - posted on 02/05/2011

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For Augmentin, from Hale's:

Amoxicillin +clavulanate (augmentin):

The amount received through breastmilk in neonates is about .5% of the typical dose directly given to a neonate who needs the medication. No pediatric concerns reported, but observe for diarrhea or rash.

Minnie - posted on 02/05/2011

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From Hale's Medications and Mother's Milk:

Hydromorphone (dilaudid) is 7-10 times more potent than morphine, but used in equivalently lower doses. Relative Infant Dose is .52-.67% of maternal dose. This is significantly less than the clinical dose directly given to infants who need painkillers themselves.

Minnie - posted on 02/05/2011

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Augmentin:

Amoxicillin and Clavulanic Acid
CASRN: 79198-29-1
For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Amoxicillin and clavulanic acid is acceptable to use during breastfeeding. Limited information indicates that serious reactions in infants are very uncommon during the use of amoxicillin-clavulanic acid during nursing, with restlessness, diarrhea and rash occurring occasionally. If amoxicillin-clavulanic acid is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for these reactions during nursing.


Drug Levels:
Maternal Levels. After a single 1 g oral dose of amoxicillin (without clavulanic acid) in 6 women, peak milk amoxicillin levels occurred 4 to 5 hours after the dose. Average milk levels were 0.69 mg/L (range 0.46 to 0.88 mg/L) at 4 hours and 0.81 mg/L (range 0.39 to 1.3 mg/L) at 5 hours after the dose.[1] Using these data, an exclusively breastfed infant would be expected to receive a maximum of about 0.1 mg/kg daily of amoxicillin with a maternal amoxicillin-clavulanate dose of 500 mg 3 times daily. This amounts to 0.25 to 0.5% of a typical infant amoxicillin dosage.

Infant Levels. Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
A small, controlled, prospective study had mothers monitor their infants for signs of adverse effects (furring of the tongue, feeding difficulties, changes in stool frequency and consistency, diaper rash, and skin rash). Weight change and the development of jaundice were also recorded. No statistical differences in these parameters were found between the infants of the control mothers and those of the 14 mothers taking amoxicillin-clavulanate.[2]

A prospective, controlled study asked mothers who called an information service about adverse reactions experience by their breastfed infants. Mothers were taking either amoxicillin or amoxicillin-clavulanic acid. Overall, adverse reactions in the infants were statistically more frequent in the amoxicillin-clavulanic acid group (22.3%) than in the amoxicillin group (7.5%) and the rate of adverse effects was dose-related. Amoxicillin-clavulanate reactions consisted of restlessness (8.9%), diarrhea (5.9%), rash (5.9%), and constipation (1.5%), although no single adverse effect was statistically more frequent than in the amoxicillin group. One infant whose mother was taking 1.5 g daily of amoxicillin-clavulanic acid developed mildly elevated liver enzymes (AST and ALT) during maternal therapy that returned to normal 10 days after discontinuation of the drug.[3]

A 2-month-old infant breastfed since birth. His mother had taken many medications during pregnancy, but she did not recall their identity. She developed mastitis and was treated with amoxicillin/clavulanic acid 1 gram orally every 12 hours and gentamicin 160 mg intramuscularly once daily. The infant was breastfed for 10 minutes starting 15 minutes after the first dose of both drugs. About 20 minutes later, the infant developed a generalized urticaria which disappeared after 30 minutes. A few hours later, the infant breastfed again and the urticaria reappeared after 15 minutes and disappeared after an hour. After switching to formula feeding and no further infant exposure to penicillins, the reaction did not reappear with follow-up to 16 months of age. The adverse reaction was probably caused by the antibiotics in breastmilk. The drug that caused the reaction cannot be determined, but it was most likely the amoxicillin/clavulanic acid.[4]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.


References:
1. Kafetzis DA, Siafas CA, Georgakopoulos PA et al. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand. 1981;70:285-8. PMID: 7246123
2. Campbell AC, McElnay JC, Passmore CM. The excretion of ampicillin in breast milk and its effect on the suckling infant. Br J Clin Pharmacol. 1991;31:230p. Abstract.
3. Benyamini L, Merlob P, Stahl B et al. The safety of amoxicillin/clavulanic acid and cefuroxime during lactation. Ther Drug Monit. 2005;27:499-502. PMID: 16044108
4. Cherif F, El Aidli S, Kastalli S et al. Drug induced urticaria via breastfeeding. Fundam Clin Pharmacol. 2009;23 (Suppl. 1):203. Abstract.



Substance Identification:


Substance Name: Amoxicillin and Clavulanic Acid

CAS Registry Number: 79198-29-1

Drug Class:
Antiinfective Agents
Antibacterial Agents
Penicillins

Administrative Information:


LactMed Record Number:
12


Last Revision Date:
20100212

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

Minnie - posted on 02/05/2011

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Dilaudid:

Hydromorphone
CASRN: 466-99-9
For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Limited data indicate that hydromorphone is excreted into breastmilk in small amounts. Maternal use of maximum doses of oral narcotics can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics, particularly in the first week of life. Once the mother's milk comes in, it is best to limit maternal intake of oral hydromorphone and to supplement analgesia with a nonnarcotic analgesic if necessary. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.


Drug Levels:
In adults, hydromorphone has an oral bioavailability of 62% and is metabolized to inactive metabolites. While not commonly used in infants, an appropriate dose for this age group is 10 mcg/kg parenterally or 30 mcg/kg orally every 4 hours as needed.

Maternal Levels. Eight lactating women (time postpartum not given) were given a single 2 mg intranasal dose of hydromorphone. Milk was collected 7 times, beginning 2 hours after and ending 24 hours after the dose. Peak milk levels occurred 2 hours after the dose. The half-life of elimination from milk was 10.5 hours. The reported average milk level, over the 24 hour period after the single dose, was about 1 mcg/L. The authors calculated that an exclusively breastfed infant would receive 0.67% of the maternal weight-adjusted dosage.[1] Using the average milk level reported in this study, an exclusively breastfed infant would receive 0.15 mcg/kg daily from a single maternal 2 mg intranasal hydromorphone dose. Intranasal hydromorphone is not currently available in the U.S.

Infant Levels. Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
Relevant published information was not found as of the revision date.


Possible Effects on Lactation:
Narcotics can increase serum prolactin.[2] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.


Alternate Drugs to Consider:
Acetaminophen, Ibuprofen, Morphine


References:
1. Edwards JE, Rudy AC, Wermeling DP et al. Hydromorphone transfer into breast milk after intranasal administration. Pharmacotherapy. 2003;23:153-8. PMID: 12587803
2. Tolis G, Dent R, Guyda H. Opiates, prolactin, and the dopamine receptor. J Clin Endocrinol Metab. 1978;47:200-3. PMID: 263291



Substance Identification:


Substance Name: Hydromorphone

CAS Registry Number: 466-99-9

Drug Class:
Analgesics, Opioid
Narcotics
Antitussive Agents
Opiates

Administrative Information:


LactMed Record Number:
360


Last Revision Date:
20101207

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

Becky - posted on 02/05/2011

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I don't know about the Augmentin (not sure what that is), but if you are not feeling super dopey from the Dilaudid, then it is okay to nurse. I had gall bladder surgery when Zach was 5 months old and asked a lactation doctor beforehand about anesthesia and pain killers. She said only very small amounts of pain killers are transmitted through your milk, so as long as you're not feeling really loopy, nursing is fine. I was on percoset for a day and nursed Zach as normal and it had no effect on him.

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