《　授乳（母乳）と喘息の薬　》

マタニティー・ママの幸せな日々を不安なく過ごすためにわたくしたちがサポートいたします。
母乳と喘息の薬に関する知識が出産後必要となります。

《　メッセージ：大部分のの薬は授乳していても大丈夫。お薬は授乳直後に飲みましょう。　》

喘息の薬「授乳（母乳）中でも常用量で安全な喘息の薬」

Safe to Take in Usual Doses

Corticosteroids, Prednisolone（全身性ステロイド）

Erythromycin（エリスロシン）

Inhalers, bronchodilators, and corticosteroids（気管支拡張剤の吸入、ステロイドの吸入）

Theophylline（テオドール、ユニコンetc）

コントロールが第一です！

＜資料１＞

Drugs and Breast Milk Interactions Chart
（薬物と母乳の相互作用）

※PDR(PHYSICIANS’ DESK REFERENCE) 57edition 2003でBrand Nameを検索して一般名を見つけ、次に

治療薬マニュアル2004（医学書院）で日本の商品名を検索した。

The information in the chart below was compiled by Philip Anderson, a pharmacist and the director of the Drug Information Service at the University of California, San Diego Medical Center. If you have more questions about how a drug you are taking may affect your breast milk or your baby, call the UCSD information service at (900) 226-7536, 9 a.m. to 5 p.m. Pacific time, Monday to Friday ($4 for the first minute, $2.50 for every additional minute).

Safe to Take in Usual Doses (常用量でも安全)

＜資料２＞

PEDIATRICS Vol. 108 No. 3 September 2001, pp. 776-789

AMERICAN ACADEMY OF PEDIATRICS:
The Transfer of Drugs and Other Chemicals Into Human Milk

（母乳への薬物移行）

Committee on Drugs

（2001アメリカ小児科学会薬事委員会）

TABLE 6 Maternal Medication Usually Compatible With Breastfeeding* （母乳育児中の投与として通常適切） Drug Reported Sign or Symptom in Infant or Effect on Lactation Reference No.   Acetaminophen None 142-144 Acetazolamide None 145 Acitretin 146 Acyclovir None 147, 148 Alcohol (ethanol) With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain; maternal ingestion of 1 g/kg daily decreases milk ejection reflex 4, 149-152 Allopurinol 153 Amoxicillin None 154 Antimony 155 Atropine None 156 Azapropazone (apazone) 157 Aztreonam None 158 B1 (thiamin) None 159 B6 (pyridoxine) None 160-162 B12 None 163 Baclofen None 164 Barbiturate See Table 5 Bendroflumethiazide Suppresses lactation 165 Bishydroxycoumarin (dicumarol) None 166 Bromide Rash, weakness, absence of cry with maternal intake of 5.4 g/d 167 Butorphanol None 168 Caffeine Irritability, poor sleeping pattern, excreted slowly; no effect with moderate intake of caffeinated beverages (2-3 cups per day) 169-174 Captopril None 175 Carbamazepine None 176, 177 Carbetocin None 178 Carbimazole Goiter 83, 179, 180 Cascara None 181 Cefadroxil None 154 Cefazolin None 182 Cefotaxime None 183 Cefoxitin None 183 Cefprozil 184 Ceftazidime None 185 Ceftriaxone None 186 Chloral hydrate Sleepiness 187 Chloroform None 188 Chloroquine None 189-191 Chlorothiazide None 192, 193 Chlorthalidone Excreted slowly 194 Cimetidine None 195, 196 Ciprofloxacin None 197, 198 Cisapride None 199 Cisplatin Not found in milk 30  Clindamycin None 200 Clogestone None 201 Codeine None 144, 156, 202 Colchicine 203-205 Contraceptive pill with estrogen/progesterone Rare breast enlargement; decrease in milk production and protein content (not confirmed in several studies) 206-213 Cycloserine None 214 D (vitamin) None; follow up infant’s serum calcium level if mother receives pharmacologic doses 215-217 Danthron Increased bowel activity 218 Dapsone None; sulfonamide detected in infant’s urine 191, 219 Dexbrompheniramine maleate with d-isoephedrine Crying, poor sleeping patterns, irritability 220 Diatrizoate None 221 Digoxin None 222, 223 Diltiazem None 224 Dipyrone None 225 Disopyramide None 226, 227 Domperidone None 228 Dyphylline None 229 Enalapril 230 Erythromycin （エリスロシン） None 231 Estradiol Withdrawal, vaginal bleeding 232 Ethambutol None 214 Ethanol (cf. alcohol)   Drug（Maternal Medication Usually Compatible With Breastfeeding* ） Reported Sign or Symptom in Infant or Effect on Lactation Reference No.   Ethosuximide None, drug appears in infant serum 176, 233 Fentanyl 234 Fexofenadine None 235 Flecainide 236, 237 Fleroxacin One 400-mg dose given to nursing mothers; infants not given breast milk for 48 h 238 Fluconazole None 239 Flufenamic acid None 240 Fluorescein 241 Folic acid None 242 Gadopentetic (Gadolinium) None 243 Gentamicin None 244 Gold salts None 245-249 Halothane None 250 Hydralazine None 251 Hydrochlorothiazide 192, 193 Hydroxychloroquine None 252, 253 Ibuprofen None 254, 255 Indomethacin Seizure (1 case) 256-258 Iodides May affect thyroid activity; see iodine 259 Iodine Goiter 259 Iodine (povidone-iodine, eg, in a vaginal douche) Elevated iodine levels in breast milk, odor of iodine on infant’s skin 259 Iohexol None 97  Iopanoic acid None 260 Isoniazid None; acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity reported in infants 214, 261 Interferon- 262 Ivermectin None 263, 264 K1 (vitamin) None 265, 266 Kanamycin None 214 Ketoconazole None 267 Ketorolac 268 Labetalol None 269, 270 Levonorgestrel 271-274 Levothyroxine None 275 Lidocaine None 276 Loperamide 277 Loratadine None 278 Magnesium sulfate None 279 Medroxyprogesterone None 201, 280 Mefenamic acid None 281 Meperidine None 61, 282 Methadone None 283-287 Methimazole (active metabolite of carbimazole) None 288, 289 Methohexital None 61  Methyldopa None 290 Methyprylon Drowsiness 291 Metoprolol None 120 Metrizamide None 292 Metrizoate None 97  Mexiletine None 293, 294 Minoxidil None 295 Morphine None; infant may have measurable blood concentration 282, 296-298 Moxalactam None 299 Nadolol None 300 Nalidixic acid Hemolysis in infant with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency 301 Naproxen 302 Nefopam None 303 Nifedipine 304 Nitrofurantoin Hemolysis in infant with G-6-PD deficiency 305 Norethynodrel None 306 Norsteroids None 307 Noscapine None 308 Ofloxacin None 198 Oxprenolol None 309, 310 Phenylbutazone None 311 Phenytoin Methemoglobinemia (1 case) 138, 176, 312 Piroxicam None 313 Prednisolone （プレドニン） None 314, 315 Prednisone （プレドニン） None 316   Drug（Maternal Medication Usually Compatible With Breastfeeding* ） Reported Sign or Symptom in Infant or Effect on Lactation Reference No.   Procainamide None 317 Progesterone None 318 Propoxyphene None 319 Propranolol None 320-322 Propylthiouracil None 323 Pseudoephedrine None 324 Pyridostigmine None 325 Pyrimethamine None 326 Quinidine None 191, 327 Quinine None 296 Riboflavin None 159 Rifampin None 214 Scopolamine 156 Secobarbital None 328 Senna None 329 Sotalol 237, 330 Spironolactone None 331 Streptomycin None 214 Sulbactam None 332 Sulfapyridine Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant’s milk 333, 334 Sulfisoxazole Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant’s milk 335 Sumatriptan None 336 Suprofen None 337 Terbutaline None 338 Terfenadine None 235 Tetracycline None; negligible absorption by infant 339, 340 Theophylline （テオドール、ユニコン） Irritability 169, 341 Thiopental None 139, 342 Thiouracil None mentioned; drug not used in United States 343 Ticarcillin None 344 Timolol None 310 Tolbutamide Possible jaundice 345 Tolmetin None 346 Trimethoprim/sulfamethoxazole None 347, 348 Triprolidine None 324 Valproic acid None 176, 349, 350 Verapamil None 351 Warfarin None 352 Zolpidem None 353   * Drugs listed have been reported in the literature as having the effects listed or no effect. The word “none” means that no observable change was seen in the nursing infant while the mother was ingesting the compound. Dashes indicate no mention of clinical effect on the infant. It is emphasized that many of the literature citations concern single case reports or small series of infants.  Drug is concentrated in human milk.

TABLE 4 Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern* （未確認だが注意が必要） Drug Reported or Possible Effect Reference No.   Anti-anxiety   Alprazolam None 57    Diazepam None 58-62   Lorazepam None 63    Midazolam 64    Perphenazine None 65    Prazepam None 66    Quazepam None 67    Temazepam 68  Antidepressants   Amitriptyline None 69, 70   Amoxapine None 71    Bupropion None 72    Clomipramine None 73    Desipramine None 74, 75   Dothiepin None 76, 77   Doxepin None 78    Fluoxetine Colic, irritability, feeding and sleep disorders, slow weight gain 79-87   Fluvoxamine 88    Imipramine None 74    Nortriptyline None 89, 90   Paroxetine None 91    Sertraline None 92, 93   Trazodone None 94  Antipsychotic   Chlorpromazine Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores 95-98   Chlorprothixene None 99    Clozapine None 100   Haloperidol Decline in developmental scores 101-104   Mesoridazine None 105   Trifluoperazine None 104 OTHERS Amiodarone Possible hypothyroidism 106 Chloramphenicol Possible idiosyncratic bone marrow suppression 107, 108 Clofazimine Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation 109 Lamotrigine Potential therapeutic serum concentrations in infant 110 Metoclopramide None described; dopaminergic blocking agent 111, 112 Metronidazole In vitro mutagen; may discontinue breastfeeding for 12-24 h to allow excretion of dose when single-dose therapy given to mother 113, 114 Tinidazole See metronidazole 115   * Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.56 See discussion in text of psychotropic drugs.  Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.