Sistematični pregled literature o varnosti uporabe analgetikov, antibiotikov in antidepresivov med dojenjem

Kozmus, Natalija (author), Kerec Kos, Mojca (mentor)

Dojenje je glavni način prehranjevanja dojenčkov. Skupaj s hranili lahko iz materinega krvnega obtoka v mleko prehajajo tudi zdravilne učinkovine, kar lahko predstavlja tveganje za dojenega otroka. V okviru magistrske naloge smo izvedli sistematični pregled literature o varnosti uživanja analgetikov, antibiotikov in antidepresivov med dojenjem. Zanimali so nas podatki o prehajanju izbranih skupin zdravilnih učinkovin v materino mleko in njihov vpliv na dojenčka. Z oblikovanjem ustreznih iskalnih profilov za posamezne skupine zdravilnih učinkovin in dodatnimi filtri (objave v angleškem jeziku od leta 2000 naprej, raziskave na ljudeh, klinične študije, meta-analize, randomizirane kontrolirane klinične študije, sistematični pregledi in pregledni članki), smo v podatkovni bazi PubMed identificirali ustrezne članke. Rezultate smo predstavili glede na posamezne farmakološke skupine zdravilnih učinkovin. Nobena skupina antibiotikov ni absolutno kontraindicirana za uporabo v času dojenja. Pri uporabi penicilinov in cefalosporinov, ki so antibiotiki prvega izbora, so pri dojenih otrocih najpogosteje poročali o pojavu gastrointestinalnih težav. Med makrolidnimi antibiotiki je zdravilo prvega izbora eritromicin. Tetraciklini in fluorokinoloni zaradi vpliva na razvoj kosti in zobovja niso prva izbira za uporabo v času dojenja, zaradi ototoksičnosti in nefrotoksičnosti se priporoča izogibanje zdravljenju z aminoglikozidi. Antidepresiva prvega izbora za zdravljenje doječih mater sta paroksetin in sertralin. Uporaba venlafaksina in fluoksetina zaradi metabolitov z dolgim razpolovnim časom ni priporočljiva. Od tricikličnih antidepresivov sta najbolj varna za uporabo pri doječih materah amitriptilin in nortriptilin. Priporoča se, da se zdravljenje začne z enim zdravilom, v najnižjem odmerku, ki se ga nato postopno titrira do najnižjih še učinkovitih odmerkov, obenem pa se svetuje tudi opazovanje otroka za spremembe v vedenju (najpogosteje so kot neželene učinke opisovali pojav letargije, sedacije in nezadostnega pridobivanja telesne mase). Za lajšanje bolečin pri doječih materah je zdravilo prvega izbora paracetamol, od nesteroidnih antirevmatikov pa ibuprofen. Varnost dolgotrajnega zdravljenja doječih mater z opioidnimi analgetiki ni bila proučevana, priporoča se previdnost predvsem pri kroničnem zdravljenju z visokimi odmerki in uporabi pripravkov s podaljšanim sproščanjem. Pri otrocih so poročali o pojavu sedacije, depresije dihanja in zaostalosti pri doseganju razvojnih mejnikov. Pri vsaki doječi materi je potreben individualen razmislek o razmerju med koristjo in tveganjem zdravljenja z zdravili. Upoštevati je potrebno zdravstveno stanje matere, vpliv zdravil na izločanje mleka, koncentracije učinkovine v mleku, otrokovo starost in možne neželene učinke, ki jih lahko povzroči izpostavljenost otroka zdravilni učinkovini.

• Language: Slovenian
• Keywords: dojenje, analgetiki, antibiotiki, antidepresivi, prehajanje v mleko, neželeni učinki pri otroku
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2021
• PID: 20.500.12556/RUL-132821
• Publication date in RUL: 04.11.2021

Secondary language

• Language: English
• Title: Systematic review on the safety of analgesics, antibiotics and antidepressants in lactation

Abstract

Breastfeeding is the most natural way of feeding infants. Together with nutrients, drugs can also pass into milk from the mother's bloodstream, which presents a risk for the breast-fed child. In our Master's thesis we conducted a systematic rewiev of the literature on the safety of the use of anagesics, antibiotics and antidepressants during lactation. The aim of our work was to gather information on the transfer of selected drug classes into breast the milk and their impact on the infant. By creating appropriate search profiles for individual groups of drugs and using additional filters (arcticles published in English lagungage since the year 2000, studies conducted on humans, cinical trials, meta-analyses, randomized control trials, reviews and systematic reviews), we identified relevant articles in the PubMed database. The results are presented according to the individual pharmacological classes of drugs. Among antibiotics no drug class is absolutely contraindicated for use during breast-feeding. During the use of penicillins and cephalosporins, which are the safest class of antibiotics during breast-feeding, gastrointestinal problems were the most commonly reported in breast-fed child. Among macrolides, the drug of choice is erythromycin. The use of tetracyclines and fluoroqinolones is not recommended due to their impact on bone and teeth development. Due to the potential ototoxicity and nephrotoxicity, it is also recommended to avoid the use of aminoglycosides during lactation. The first-line antidepressants for the treatment of breast-feeding women are paroxetine and sertraline. The use of venlafaxine and fluoxetine is not recommended due to their metabolites with long half-life. The tricyclic antidepressants of choice are amitriptyline and nortriptyline. It is advisable to start the treatment using the lowest dose of one drug, which can then be slowly titrated to the lowest yet effective dose. Infant monitoring for behaviour changes (lethargy, sedation and weight-loss) is advisable. Paracetamol and ibuprofen are the drugs of choice for pain relief in breast-feeding mothers. The safety of long-term opioid use during lactation has not been well-established. Special caution is advised with long-term treatment with high dosees and with the use of prolonged release dosage forms. Sedation, respiratory despression and impact on neurobehavioral development were the most commonly described adverse drug reactions in breastfed infants.

• Keywords: breastfeeding, analgesics, antibiotics, antidepressants, milk transfer, infant adverse drug reactions