毒理性
◉ 母乳喂养期间使用概述:有限的数据表明,在静脉输注结束后4到6小时内,极小量的右美托咪定会排入母乳中。在输注结束24小时后,药物在母乳中不再存在。预计舌下使用后乳汁中的量将小于静脉输注后的量。由于乳汁中剂量较低且口服生物利用度差,右美托咪定不太可能导致母乳喂养的婴儿或新生儿出现不良反应。在舌下使用期间,监测母乳喂养婴儿的烦躁情况。
◉ 对母乳喂养婴儿的影响:截至修订日期,未找到相关已发布信息。
◉ 对泌乳和母乳的影响:在一项双盲研究中,将160名在脊髓麻醉下接受选择性剖宫产的妇女随机分配到接受舒芬太尼患者自控静脉镇痛(标准治疗)的组或标准治疗加右美托咪定的组。右美托咪定的剂量为5微克/千克,随后以0.5微克/千克/小时的速度持续输注直至手术结束。后一组患者在术后2天内接受右美托咪定加舒芬太尼的患者自控静脉镇痛。接受右美托咪定的患者第一次泌乳的时间更短(28小时对34小时),更快实现纯母乳喂养(8天对11天),且产后第二天乳汁量更多。
在一项回顾性研究中,比较了接受剖宫产的三种方案:麻醉前和分娩期间使用右美托咪定(n = 115),麻醉前和分娩期间使用生理盐水,分娩后使用右美托咪定(n = 109),以及麻醉前和分娩期间使用生理盐水(n = 168)。与其它组相比,麻醉前和分娩期间接受右美托咪定的妇女在住院期间消耗的舒芬太尼和昂丹司琼较少,且第一次产生乳汁的时间略短(25分钟对27至28分钟)。
◉ Summary of Use during Lactation:Limited data indicate that very small amounts of dexmedetomidine are excreted into breastmilk for 4 to 6 hours after the end of an intravenous infusion. The drug is absent from breastmilk by 24 hours after the end of an infusion. The amounts in milk after sublingual use are expected to be less than after intravenous infusion. Because of the low dose in milk and its poor oral bioavailability, dexmedetomidine would not be expected to cause adverse effects in breastfed infants or neonates. Monitor the breastfed infant for irritability during sublingual use.
◉ Effects in Breastfed Infants:Relevant published information was not found as of the revision date.
◉ Effects on Lactation and Breastmilk:A double-blind study randomized 160 women receiving an elective cesarean section under spinal anesthesia to receive either sufentanil for patient-controlled intravenous analgesia (standard care) or standard care plus dexmedetomidine. Dexmedetomidine was given as 5 mcg/kg, followed by a continuous infusion of 0.5 mcg/kg per hour until the end of surgery. Patient in this latter group received dexmedetomidine plus sufentanil for patient-controlled intravenous analgesia postoperatively for 2 days. Patients who received dexmedetomidine had a shorter time to the first lactation (28 vs 34 hours), achieved exclusive breastfeeding sooner (8 vs 11 days) and had a greater amount of milk on the second day postpartum.
In a retrospective study of women undergoing cesarean section deliveries, 3 regimens were compared: dexmedetomidine before anesthesia and during delivery (n = 115), normal saline before anesthesia and during delivery and dexmedetomidine after delivery (n = 109), and normal saline before anesthesia and during delivery (n = 168). Women who received dexmedetomidine before anesthesia and during delivery consumed less sufentanil and ondansetron during their hospitalization and had a slightly shorter time to the first production of milk than women in the other groups (25 minutes vs 27 to 28 minutes).
来源:Drugs and Lactation Database (LactMed)