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Generally, adult glomerular filtration rates (adjusted for the difference in surface area) are attained by five to six months of age.
Drugs such as lithium (infant dose as high as 80% of the weight-adjusted maternal dose) and amiodarone (infant dose up to 50%) should be avoided due to high infant exposure and potential for significant toxicity.
For drugs with greater inherent toxicity such as cytotoxic agents, ergotamine, gold salts, immunosuppressives and isotretinoin, the cut-off of 10% is too high and breastfeeding is contraindicated.
Other factors to consider in conjunction with the infant's dose include the pharmacokinetics of the drug in the infant.
Generally, drugs that are poorly absorbed or have high first-pass metabolism are less likely to be problematical during breastfeeding.
The infant almost invariably receives no benefit from this form of exposure and is considered to be an 'innocent bystander'.
Drug transfer from maternal plasma to milk is, with rare exceptions, by passive diffusion across biological membranes.
The following table is useful for estimating infant clearance.
Table 1: Approximate clearance values at different ages The overall risk of a drug to a breastfed infant depends on the concentration in the infant's blood and the effects of the drug in the infant.
If, after assessment of the risks and benefits, the decision is made to breastfeed while the mother is using a drug, the infant should be monitored for adverse effects such as failure to thrive, irritability and sedation.
However, it is difficult to identify adverse reactions occurring in neonates.
Transfer of drugs into breast milk is most commonly described quantitatively using the milk to plasma (M/P) concentration ratio.Tags: Adult Dating, affair dating, sex dating