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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For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.