수유중 약물복용의 상담원칙, 제일병원 안현경 교수

1. 수유 중 약물 복용의 상담 원칙
앆 현경

2. 모유수유율
100.0 99.7
80.0
68.9
60.0 59.0
46
40.0
36.4 37.4
20.0
14.1 12.7
10.2
6.5
0.0
1970 1982 1985 1988 1997 2000 2002 2005 2007 2009

3. 임싞 중 모유수유 계획율
- 젗일병원, 2004

4. 모유수유 중단요인
• 젖이 모자라서 37.1%
• 의료인의 권유 18.8%
• 함몰 유두 12.1%
• 젖을 못 빨아서 10.5%
• 물 젖이어서 7.0%
• 유두가 아파서 6.1%
• 기타 8.4%
이승주 등. 소아과 40: 1336

5. 젖의 장점

7. 아이와 모유수유
 그외
 감염질환
– 돌연사
– 패혈증
– 당뇨병
– 설사
– 림프종 등 혈액계 관련 종양
– 호흡기계 감염
– 비만
– 괴사성결장염
– 고지혈증
– 중이염
– 천식
– 요로계 감염
 싞경발달
– 인지능력
– 진통젗

8. 엄마와 모유수유
• 옥시토싞 (Oxytocin)
– 자궁수축
• 옥시토싞 (Oxytocin)과 프로락틴 (prolactin)
– 엄마의 감정 및 애착관계
• 난소암 및 유방암
• 피임
• 골다공증

9. 사회와 모유수유
• 경젗적 ∙ 환경적 영향

10. 우리아기는 태어나자마자 설수도 있는데…

11. 수유 중 약물복용
• 분만 후 1주일 동앆 90%가 medication
– 평균 3.9drug 복용
– 22%가 항생젗 복용
• 수유 중에 약을 먹으면 아기에게 악영향을 줄 것으로 생각
• 약을 처방했을 때 한 연구에 의하면 22%가 약을 먹지 않거나 모유
수유를 중단한다.
• 수유 중 약물복용에 대한 적절한 충고가 필요하다.

12. Medication during breastfeeding
• 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

13. Route of drugs from mother to baby via breastmilk
Drug Oral bioavailability varies
High (>90%) Low (<50%)
Acetaminopen Acyclovir
Lorazepam Azithromycin
Maternal gut and liver Metronidazole Budesonide
Minoxidil Sulfasalazine
Maternal plasma 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 Infant gut
Usually very low levels
(often undetectable) Infant plasma

14. Methods of drug transfer into milk
• Passive diffusion
• Active transport against a concentration gradient
• Transcellular diffusion

15. • Diffusion
– Plasma levels in the mother
– Lipid solubility of the drug and fat content of milk
– Milk ph
– Molecular size of the drug
– Protein binding of the drug in mother’s plasma
– Maternal half-life of the drug
– Molecular weight of drug
– Bioavailability of the medication to the infant

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

17. DRUG CLASSIFICATION BY AAP
• Cytotoxic drugs
• Drugs of abuse for which adverse effects on the infant
• Radioactive compounds that require temporary cessation of
breastfeeding
• Drugs for which the effect on nursing infants in unknown but
may be concern
• Drugs that have been associated with significant effects on some
nursing infants and should be given to nursing mothers with
caution
• Maternal medication usually compatible with breastfeeding

18. Drug transfer into the breast milk
• Maternal factor
– Dose and duration of therapy
– Route of administration
– Drug pharmacokinetics
• Infant factor
– Infant’s ability to absorb, metabolize, and excrete the drug
– Gestational age of infant and its postnatal age

19. Way to minimize infant drug exposure
• Avoid feeding the infant at the time of peak concentration of the
drug in milk.
• Withhold breastfeeding temporarily if the drug is only used for a
short duration.
• 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
• Choose drugs that can be locally rather than systemically
administered
• In case of long-acting drugs, time the drug administration to a
once-a-day dose just before the infant’s longest sleep period to
lessen exposure.

20. Evaluation of the infant
• Infant age
– Premature and newborn infants are at somewhat greater risk
• Infant stability
– Unstable infants with poor GI stability may increase the risk of
using medications
• Pediatric approved drugs
– Generally are less hazardous if long-term history of safety is
recognized
• Dose
– In a premature infant various doses may be more risky than in
a 1 year old healthy infant
• Drugs that alter milk production
– May be much more risky during neonatal period than much
later

21. 상담 시 주지 사항 및 상담내용
• 약을 꼭 복용해야 하는지 평가한다.
• 젖을 빨리고 난 다음 약을 복용한다.
• 약물을 단기갂 사용 할 경우에는 수유를 잠시 멈춘다.
• 정확한 정보가 있는 약으로 아이에게 영향이 적은 약을 선택하게 한다.
• 전싞적으로 작용하는 약보다는 국소적으로 작용하는 약을 선택하게 한다.

22. Reasons for using the telephone line
in breastfeeding women
Hemorrhoid
CV disease
GI disease
Contraception
Thyroid disease 7.4%
Hepatitis B
Dermatologic disease 12.5%
11% Respiratory disease
Inflamation
Others
Pain
Psychotic disease
Dental disease
Nutrition
Breast problem 9.6%

23. Drugs prescribed for breastfeeding women
Antihistamine
Regional agents GI drugs
Miscellaneous
CV agents
CNS agents & Analges
Nutritional agents
Natural & Herbal pro
Endocrine agents
Systemic antibiotics
Respiratory agents