毒理性
哺乳期使用概要:哺乳期间母亲口服阿片类药物可能会导致婴儿昏睡和严重的中枢神经系统抑制。与可待因类似,药代遗传学可能在阿片类药物导致的中枢神经系统抑制程度中发挥作用。新生儿似乎对即使是很小的阿片类镇痛药剂量都非常敏感。在一项案例中,一名母亲服用二氢可待因为咳嗽治疗,可能导致其新生儿出现严重的呼吸抑制。一旦母亲的乳汁开始分泌,最好使用非阿片类镇痛药来控制疼痛,并将母亲的氢吗啡酮摄入量限制在2到3天内的低剂量,并密切监测婴儿。如果婴儿表现出过度昏睡(比平时更甚)、哺乳困难、呼吸问题或肢体无力,应立即联系医生。由于关于哺乳期间使用二氢可待因的已发表经验很少,可能更倾向于使用其他药物,特别是在哺乳新生儿或早产儿时。
◉ 对哺乳婴儿的影响:一名妇女在分娩后第一天开始每天两次服用二氢可待因滴剂(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%。在医院观察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二氢可待因引起的。
◉ 对泌乳和乳汁的影响:阿片类药物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)