毒理性
◉ 母乳喂养期间使用总结：由于在一些母乳喂养的婴儿中发现了较高的血清水平，可能的婴儿副作用，以及对哺乳的潜在负面影响，首选其他抗高血压药物，特别是在喂养新生儿或早产儿时。虽然可能尚未研究，但作为硬脊膜外镇痛辅助的单次产后剂量的可乐定可能减少对其他药物或其剂量的需求，并且似乎不太可能影响哺乳。
◉ 对母乳喂养婴儿的影响：在9名母亲服用可乐定的婴儿中，尽管婴儿的血清水平约为母亲的一半，但没有看到典型的可乐定副作用（例如，口干，镇静）。
三名母亲每天两次服用150微克可乐定的婴儿进行了母乳喂养。在产后前3天内，对血糖、心电图或血压没有不良影响。这些婴儿在1岁时有正常的生长和运动发育，尽管没有说明母乳喂养和可乐定使用的持续时间。
一名在怀孕和产后每天服用0.15毫克可乐定的母亲生下了一名婴儿。在出生后2天，婴儿出现嗜睡、肌张力低下和疑似全身性癫痫发作。在出生后第5天，注意到了呼吸暂停的发作。在出生后第9天停止哺乳后，所有症状在24小时内消失。可乐定可能是反应的原因，但无法确定怀孕期间和哺乳期间暴露的相对贡献。
◉ 对哺乳和母乳的影响：可乐定对催产素和催乳素分泌有复杂、剂量相关的影响。药物对哺乳母亲的总效果尚未得到很好的研究。一名6岁男孩因多动症服用可乐定和丙戊酸治疗癫痫时出现了高催乳素血症和男性乳房发育症。停用可乐定后3周内，乳汁分泌停止。还报告了一例可乐定引起的产后乳汁分泌过多的情况。在已经建立哺乳的母亲中，母体催乳素水平可能不会影响她的哺乳能力。
◉ Summary of Use during Lactation:Because of the high serum levels found in some breastfed infants, possible infant side effects, and the possible negative effects on lactation, other antihypertensive agents are preferred, especially while nursing a newborn or preterm infant. Clonidine used as a single postpartum dose as a neuraxial analgesia adjunct probably has not been studied, but it may reduce the need for other medications or their dosages, and appears unlikely to affect breastfeeding.
◉ Effects in Breastfed Infants:No typical clonidine side effects (e.g., dry mouth, sedation) were seen in 9 infants whose mothers were taking clonidine, despite the infants' serum levels being about half that of their mothers'.
Three infants whose mothers were taking clonidine 150 mcg twice daily were breastfed. During the first 3 days postpartum, no adverse effects on blood glucose, electrocardiogram or blood pressure. The infants had normal growth and psychomotor development at 1 year of age, although the duration of breastfeeding and clonidine use was not stated.
An infant was born to a mother taking clonidine 0.15 mg daily during pregnancy and postpartum. At 2 days of life, the infant presented with drowsiness, hypotonia, and suspected generalized seizures. At day 5, episodes of apnea were noted. On day 9 postpartum, breastfeeding was stopped and all symptoms resolved within 24 hours. Clonidine was probably the cause of the reaction, but the relative contributions of exposure during pregnancy and breastfeeding cannot be determined.
◉ Effects on Lactation and Breastmilk:Clonidine has complex, dose-related effects on both oxytocin and prolactin secretion. The net effect of the drug on nursing mothers has not been well studied. A case of hyperprolactinemia and gynecomastia occurred in a 6-year-old boy taking clonidine for hyperactivity and valproic acid for a seizure disorder. Galactorrhea ceased within 3 weeks of discontinuing clonidine. A case of clonidine-induced postpartum galactorrhea has also been reported. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.
来源:Drugs and Lactation Database (LactMed)
