H2receptor blockers and other ulcer therapeutics

Experience

Among the ulcer medications of the H2-receptor blocker type are cimetidine, famotidine, nizatidine, ranitidine, and roxatidine,

Cimetidine and ranitidine reach relatively high concentrations in mother's milk. According to a study on 12 women who received single doses of 100, 600 or 1200 mg, cimetidine was actively transported into the milk with an M/P ratio of about 5. The infant received, on average, 6.7% of the maternal weight-related dosage, although the maximum was 20% (Oo 1995).

With maternal therapy of 150-300 mg of ranitidine daily, a relative dosage of up to 20% can reach the infant. The M/P ratio varies between 1 and over 20 (survey in Bennett 1996, Kearns 1985).

According to a study of eight mothers receiving a single dose of 40 mg famotidine, the relative dosage in the milk was under 2% (Courtney 1988).

With nizatidine therapy, a maximum of 5% of the maternal weight-related dosage can be assumed (Obermeyer 1990). This was reported in five mothers who received 150 mg every 12 hours. Among 10 women studied following a single dose of 150 mg of roxatidine, this was on average 4%. However, a higher amount might reach the infant when therapy is ongoing (Bender 1989).

A case report on omeprazole calculated a weight-adjusted dosage for a fully breastfed infant of less than 7% (Marshall 1998). Another case report of pantoprazole (40 mg) found a weight-adjusted dosage of <1% (Plante 2004). There were no symptoms observed in the breastfed infants.

There is insufficient documented experience with the protonpump inhibitors esomeprazole, lansoprazole, and rabeprazole. This also applies to the so-called Mrreceptor blocker pirenzepine, the gastrin reccptor antagonist proglumide, as well as the bismuth combinations bismuth nitrate, bismuth salicylate, dibismuth-tris, and bismuth (Ill)-citrate hydroxide complex. For the prostaglandin derivative, see Chapter 4.11.13.

4.3.3 Peristaltic stimulators

Recommendation. H2-blockers may be given during lactation. Those with low concentration in breast milk should be preferred - for example, famotidine or nizatidine. If proton-pump blockers are indicated, omeprazole or pantoprazole should be chosen. Single doses of other medications do not require any limitation of breastfeeding, but a change in therapy is desirable.

For the eradication of Helicobacter pylori, see the appropriate substances and Chapter 2.5.

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New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

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