毒理性
◉ 母乳喂养期间使用总结：有限的数据表明，螺内酯在母乳中的排泄很少。在螺内酯治疗期间哺乳的母亲案例中，婴儿未出现不良反应。螺内酯在哺乳期间使用似乎是可接受的。
◉ 对哺乳婴儿的影响：在一项研究中，一个17天大的母乳喂养婴儿（喂养程度未说明），其母亲自怀孕以来每天四次服用25毫克螺内酯，血清钠和钾保持正常。
另一位母亲在哺乳新生儿时，每隔一天口服螺内酯75毫克。她还在服用每8小时一次的400毫克布雷硫胺、每天25毫克的阿替洛尔、每天三次每次20毫克的普萘洛尔，以及多种维生素、钾和镁的补充剂。婴儿出生后60小时出现了黄疸，认为与药物无关，但已解决。婴儿在出生后头4个月内的体重增长和发展情况适当。
一位跨性别女性为了抑制睾酮，每天两次服用螺内酯50毫克，每天三次服用多潘立酮10毫克，后增加至每天四次每次20毫克，每天口服微粒化黄体酮200毫克和口服雌二醇8毫克，并每天6次泵乳以诱导泌乳。治疗3个月后，将雌二醇方案改为每天0.025毫克的贴剂，并将黄体酮剂量降低至每天100毫克。两周后，她开始专门哺乳伴侣的新生儿。哺乳是专门进行的，持续了6周，期间婴儿的生长、发展和肠道习惯都是正常的。患者至少在6个月内部分哺乳婴儿。
一位患有Gitelman综合症的女性在哺乳婴儿期间，服用不明确剂量的螺内酯以及钾和镁补充剂至少4个月。未报告婴儿出现不良反应。
◉ 对泌乳和母乳的影响：强烈的利尿作用可能会抑制泌乳；然而，单独的螺内酯可能不足以产生这种效果。
螺内酯可能会导致男性乳房发育。估计的风险是每1000名患者中有52例，这是基线风险的8.4倍。
◉ Summary of Use during Lactation:Limited data indicate that spironolactone is poorly excreted into breastmilk. Case of mothers breastfeeding during spironolactone therapy reported no adverse effects in infants. Spironolactone appears to be acceptable to use during breastfeeding.
◉ Effects in Breastfed Infants:In 17-day-old breastfed (extent not stated) infant whose mother was taking 25 mg of spironolactone 4 times daily since pregnancy, serum sodium and potassium remained normal.
Spironolactone 75 mg every other day was taken orally by a mother while nursing a newborn. She was also taking 400 mg of bretylium tosylate every 8 hours, atenolol 25 mg daily, propranolol 20 mg 3 times a day, and multivitamin, potassium and magnesium supplements. Jaundice, thought to be unrelated to the drug, occurred at 60 hours of age, but resolved. The infant had appropriate weight gain and development during the first 4 months of life.
A transgender woman took and spironolactone 50 mg twice daily to suppress testosterone, domperidone 10 mg three times daily, increasing to 20 mg four times daily, oral micronized progesterone 200 mg daily and oral estradiol to 8 mg daily and pumped her breasts 6 times daily to induce lactation. After 3 months of treatment, estradiol regimen was changed to a 0.025 mg daily patch and the progesterone dose was lowered to 100 mg daily. Two weeks later, she began exclusively breastfeeding the newborn of her partner. Breastfeeding was exclusive for 6 weeks, during which the infant's growth, development and bowel habits were normal. The patient continued to partially breastfeed the infant for at least 6 months.
A wonam with Gitleman syndrome took spironolactone in an unspecified dosage along with potassium and magnesium supplements for at least 4 months while breastfeeding her infant. No adverse infant effets were reported.
◉ Effects on Lactation and Breastmilk:Intense diuresis can suppress lactation; however, it is unlikely that spironolactone alone is sufficiently potent to cause this effect.
Spironolactone can cause gynecomastia. The estimated risk is 52 cases per 1000 patients treated, which is 8.4 times the baseline risk.
来源:Drugs and Lactation Database (LactMed)
