急...請幫我看藥物影響(英文版)...感激不盡

一個多月嚴重失眠,有幾天還完全沒睡

打過電話給陳昭惠醫師詢用藥,下面是她提供的網站(lactmed)查詢結果

Lorazepam哺乳時能用嗎?

英文通媽媽幫我看一下,如果不行,我可能還要找其他藥或換醫生或斷母奶

感激不盡

**********************************************

Drug Levels and Effects:

Summary of Use during Lactation:

Lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is administered directly to infants. Lorazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.

Drug Levels:

Maternal Levels. Four women were given 3.5 mg of lorazepam orally 2 hours before undergoing cesarean section. Colostrum levels of lorazepam averaged 8.5 mcg/L at 4 hours after the dose; conjugated lorazepam metabolites were not measured.[1]

Another woman taking 2.5 mg orally twice a day for the first 5 days postpartum had milk levels of free and conjugated lorazepam of 12 and 35 mcg/L, respectively, at an unspecified time on day 5.[2] Since infants can deconjugate and absorb glucuronides, the total drug level is probably more important than the free drug alone. Using the total amount excreted, an exclusively breastfed infant would receive about 7 mcg/kg daily with this maternal dosage or about 8.5% of the maternal weight-adjusted dosage.

A woman who was 4 weeks postpartum was taking lorazepam 2.5 mg 1 to 3 times daily and lormetazepam, which is partially metabolized to lorazepam, 2 mg once daily. On day 5 of therapy after taking 2 doses of lorazepam in the previous 8 hours, her lorazepam milk level was 123 mcg/L. On day 6 after having taken 3 doses in the previous 24 hours, her milk lorazepam level was 89 mcg/L. On day 7, milk levels were 55 and 40 mcg/L at 14 and 18.5 hours after her last dose, respectively.[3]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants:

In one case, the newborn infant of a mother taking 2.5 mg of lorazepam orally twice daily for 5 days after delivery showed no signs of sedation.[2]

Possible Effects on Lactation:

Relevant published information was not found as of the revision date.

AAP Category:

Effect on nursing infant is unknown but may be of concern.[4]

Alternate Drugs to Consider:

Midazolam, Oxazepam

References:

1. Summerfield RJ, Nielsen MS. Excretion of lorazepam into breast milk. Br J Anaesth. 1985;57:1042-3. Letter. PMID: 4041315

2. Whitelaw AGL, Cummings AJ, McFadyen IR. Effect of maternal lorazepam on the neonate. Br Med J (Clin Res Ed). 1981;282:1106-8. PMID: 6113019

3. Lemmer P, Schneider S, Muhe A, Wennig R. Quantification of lorazepam and lormetazepam in human breast milk using GC-MS in the negative chemical ionization mode. J Anal Toxicol 2007;31:224-6. PMID: 17555647

4. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352

Substance Identification:

Substance Name: Lorazepam

CAS Registry Number: 846-49-1

Drug Class:

Hypnotics and Sedatives

Anti-Anxiety Agents

Benzodiazepines

Administrative Information:

LactMed Record Number:

364

Last Revision Date:

20071227

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

推一下