毒理性
哺乳期间使用概要:哺乳期母亲口服麻醉剂可能会导致婴儿昏昏欲睡,严重的中枢神经系统抑制。与可待因类似,药物遗传学可能在中枢神经系统抑制的程度中发挥作用。新生儿似乎对即使是小剂量的麻醉性镇痛剂的影响也非常敏感。在一项研究中,双氢可待因可能导致了接受该药物治疗咳嗽的母亲的新生儿严重呼吸抑制。一旦母亲的乳汁开始分泌,最好使用非麻醉性镇痛剂来控制疼痛,并将母亲的氢吗啡酮摄入量限制在2到3天,剂量较低,并且密切监测婴儿。如果婴儿表现出过度嗜睡(比平时更甚)、哺乳困难、呼吸问题或无力,应立即联系医生。由于关于哺乳期间使用双氢可待因的已发表经验很少,可能更倾向于选择另一种药物,特别是在哺乳新生儿或早产儿时。
◉ 对哺乳婴儿的影响:一名妇女从分娩后第一天开始,每天两次服用双氢可待因滴剂(5.28毫克)治疗咳嗽。一天后,她的哺乳婴儿难以唤醒,并且哺乳情况不佳。婴儿出现了心动过缓、低血糖和血氧饱和度为85%。在医院住了24小时后,所有症状都得到了解决。这些症状可能是由乳汁中的双氢可待因引起的。
◉ 对泌乳和母乳的影响:麻醉剂可以增加血清催乳素水平。然而,对于已经建立泌乳的母亲来说,催乳素水平可能不会影响她的哺乳能力。
◉ Summary of Use during Lactation:Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, and severe central nervous system depression. Like codeine, pharmacogenetics probably plays a role in the extent of central nervous system depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Dihydrocodeine possibly caused severe respiratory depression in one newborn infant whose mother was taking the drug for cough. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of hydromorphone to 2 to 3 days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Because there is little published experience with dihydrocodeine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
◉ Effects in Breastfed Infants:A woman began taking dihydrocodeine drops for cough twice daily (5.28 mg) beginning on the first day postpartum. One day later, her breastfed infant was difficult to arouse and was not breastfeeding well. The infant had bradycardia, hypoglycemia, and an oxygen saturation of 85%. After 24 hours in the hospital, all symptoms resolved. The symptoms were possibly caused by dihydrocodeine in milk.
◉ Effects on Lactation and Breastmilk:Narcotics can increase serum prolactin. However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.
来源:Drugs and Lactation Database (LactMed)