毒理性
哺乳期使用总结:在哺乳期间,偶尔的小剂量服用克立马丁是可以接受的。较大剂量或更长时间的使用可能会导致婴儿出现嗜睡和其他副作用,或者减少乳汁供应,尤其是与伪麻黄碱等拟交感神经药联合使用时,或者在哺乳尚未稳定建立之前。许多女性在最后一次喂奶后睡前单次给药可能就足够了,并且这样可以最小化药物的影响。首选的非嗜睡性抗组胺药作为替代品。
对哺乳婴儿的影响:一名正在服用克立马丁、苯妥英和卡马西平的母亲的10周大哺乳婴儿出现了嗜睡、拒绝进食、烦躁不安和高音哭泣。这些副作用可能是由母乳中的克立马丁引起的,但其他药物也可能有所贡献。
在一项电话随访研究中,母亲报告称,暴露于各种抗组胺药的婴儿中有10%出现了烦躁和肠绞痛症状,1.6%的婴儿出现了嗜睡。没有任何反应需要医疗关注。
对哺乳和母乳的影响:相对高剂量的抗组胺药通过注射给药可以减少非哺乳期妇女和早期产后期妇女的基础血清催乳素。然而,哺乳诱导的催乳素分泌不受产后母亲抗组胺药预处理的影响。尚未研究较低口服剂量的抗组胺药是否对血清催乳素有相同的影响,或者对催乳素的影响是否对哺乳成功有任何后果。在已建立哺乳的母亲中,催乳素水平可能不会影响她的哺乳能力。
◉ Summary of Use during Lactation:Small occasional doses of clemastine are acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
◉ Effects in Breastfed Infants:A 10-week-old breastfed infant whose mother was taking clemastine, phenytoin and carbamazepine was drowsy, refused to feed, was irritable, and had high-pitched crying. These side effects were possibly caused by clemastine in breastmilk, but the other drugs could also have contributed.
In one telephone follow-up study, mothers reported irritability and colicky symptoms 10% of infants exposed to various antihistamines and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.
◉ Effects on Lactation and Breastmilk:Antihistamines in relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women. However, suckling-induced prolactin secretion is not affected by antihistamine pretreatment of postpartum mothers. Whether lower oral doses of antihistamines have the same effect on serum prolactin or whether the effects on prolactin have any consequences on breastfeeding success have not been studied. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
来源:Drugs and Lactation Database (LactMed)