Vein therapeutics and other local therapeutics

Experience

Local sclerosing therapy to treat varicose veins usually involves sodium tetradecyl sulfate or polidocanol, which irritates the intima of the vein. It is injected into the empty vein and compression bandages are applied, keeping the leg elevated. It takes about 3 weeks for the vein to sclerose. The chemical is removed from the vein within a few hours. It is not circulated or absorbed, and is safe during lactation (Beers 1999).

Aescein preparations (horse-chestnut extract) are insufficiently studied. Use of the crude unprocessed forms are highly toxic. Horse-chestnut cream is applied to the legs for varicose veins. A well-manufactured product is standardized to contain 16-20% aescin. Venastat is a delay-release capsule that is also used. No side effects are reported. It is approved for lactation by the German Commission.

Hemorrhoid medications commonly contain local analgesics or anesthetics, and anti-inflammatory agents. To relieve local pain, lido-caine 1-2% is often used. Lidocaine has been measured in human milk, where it is calculated to be 40% of the maternal plasma level. When lidocaine was given intravenously for maternal ventricular arrhythmia, the breastfeeding infant received an estimated 2mg/day. Lidocaine is poorly absorbed orally (35%), so little would be absorbed via the milk. Thus the local use of preparation by the lactating women would have negligible effect on the infant (Giuliani 2001). When used for dental block and other local procedures, the dose is usually less than a total of 40 mg. On the other hand, the dose used for local liposuction is quite large.

Common zvart removal medications usually contain a collodion solution with 10-20% salicylic acid and lactic acid. The dose is small, depending on the size and number of the lesions. There is minimal absorption from these lesions. Although milk levels have not been reported, acetylsalicylic acid has been evaluated and is considered safe during lactation (see Chapter 4.1). Salicylic acid does not bind to platelets or cause Reye's syndrome.

Genital or veneral warts are condylomata acuminata caused by the human papilloma virus (HPV) of several types, especially 6 and 11. Treatment is usually by electrocautery, laser, cryotherapy, or surgical excision. Chemical abalation can be used, and involves the use of topical antimitotics such as podophyllotoxin, podophyllin, or 5-fluorouracil, or caustics such as trichloroacetic acid. Interferon-inducers such as imiquimode are also used, and again require multiple applications. Information about these chemicals while breastfeeding is not available, but both the area treated and the dosage are small. Interferon is known to be a large molecule that does not pass into milk even during systemic treatment. The development of the HPV vaccine has shown a decrease in the incidence of these lesions, and will perhaps decrease the need for these medications.

Recommendation. Most agents used topically to remove small growths are acceptable. Treatments utilizing lidocaine are safe in small doses (i.e. for hemorrhoids) during lactation. Sclerotherapy is considered safe during lactation. Horse chestnuts are toxic, and their products should be avoided during lactation.

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New Mothers Guide to Breast Feeding

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