毒理性
哺乳期使用总结:在用于医疗指征的剂量下,有限的证据表明,甲基phenidate在乳汁中的水平非常低,在婴儿血清中检测不到。如果母亲需要服用甲基phenidate,这不是停止哺乳的理由。高剂量的甲基phenidate可能会干扰乳汁生产,尤其是在哺乳期未建立良好的妇女中。
对哺乳婴儿的影响:8名婴儿中有7名,其母亲服用右旋苯丙胺(平均剂量每日25毫克)或甲基phenidate(平均剂量每日52毫克)接受了临床评估。这些婴儿没有药物相关的不良反应,并且按照他们的年龄(平均4.4个月)正常发育。
一名6.4个月大的婴儿主要接受一名每周5天服用甲基phenidate 40毫克两次的母亲的哺乳,持续了5.5周。母亲报告说,婴儿的睡眠、饮食和体重增长正常。这个病人可能是上述同一作者报告中的其中一人。
一名母亲在分娩后5周开始服用舍曲林50毫克/日和甲基phenidate,其婴儿正在哺乳(程度未说明)。剂量从10毫克/日起,使用即释产品,逐渐增加到72毫克/日的缓释产品。14周时,婴儿发育正常,没有喂养困难。6个月和1岁时进行的检查发现孩子没有发育问题。
一名哺乳母亲因ADHD、广泛性焦虑症、边缘型人格障碍和抑郁症服用缓释甲基phenidate(Concerta)36毫克/日和度洛西汀90毫克/日。她部分哺乳(量未说明)约1个月。6个月时,婴儿的发育被认为是正常的,除了由先天性肺气道畸形引起的复发性肺炎。
一名患有发作性睡病的妇女在怀孕期间停用了甲基phenidate,但在怀孕和产后期间继续服用舍曲林100毫克和孕妇维生素。她挤出母乳进行瓶喂,婴儿只喝母乳直到6个月大,7个月大时断奶。当她的小儿13周大时,她恢复了甲基phenidate 10毫克,每日三次。婴儿在6个月大时达到了所有的成长里程碑。
对哺乳和母乳的影响:甲基phenidate降低了血清催乳素,但截至修订日期,尚未找到关于甲基phenidate对乳汁产生影响的的研究。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。
一名15岁女孩已经服用甲基phenidate 54毫克/日的渗透释放片(OROS)2年。开始服用舍曲林50毫克/日治疗抑郁症,并增加到100毫克/日,同时服用0.5毫克/日的氯丙嗪。治疗12周后,学校注意力不集中和头痛促使从OROS产品改为一种改良释放甲基phenidate产品(品牌未指定),剂量为30毫克/日,然后增加到50毫克/日。剂量增加三天后,女孩双侧乳房自发分泌乳汁,随后血清催乳素升高至67.7 mcg/L。停用甲基phenidate和氯丙嗪,但继续使用舍曲林。一周后,乳汁过多完全解决。药物停用15天后,女孩的催乳素水平恢复正常,为19.4 mcg/L。
◉ Summary of Use during Lactation:In dosages prescribed for medical indications, limited evidence indicates that methylphenidate levels in milk are very low and not detectable in infant serum. If methylphenidate is required by the mother, it is not a reason to discontinue breastfeeding. It is possible that large dosages of methylphenidate might interfere with milk production, especially in women whose lactation is not well established.
◉ Effects in Breastfed Infants:Seven of 8 infants, whose mothers were taking either dextroamphetamine (average dosage 25 mg daily) or methylphenidate (average dosage 52 mg daily) were clinically evaluated. The infants had no drug-related adverse reactions and were developing normally for their ages which averaged 4.4 months.
One 6.4-month-old infant was mostly breastfed by a mother who had been taking methylphenidate 40 mg twice daily 5 days/week for 5.5 weeks. The mother reported that the infant was sleeping, eating and gaining weight normally. This patient might have been one of those in the report above by the same authors.
An infant was being breastfed (extent not stated) by a mother who began taking sertraline 50 mg daily and methylphenidate after 5 weeks postpartum. Dosage was started at 10 mg daily with an immediate-release product and gradually increased to 72 mg daily of an extended-release product. At 14 weeks of age, the infant was developing normally with no feeding difficulties. Examinations at 6 months and 1 year of age found no developmental problems in the child.
A nursing mother was taking extended-release methylphenidate (Concerta) 36 mg daily and duloxetine 90 mg daily for ADHD, generalized anxiety disorder, borderline personality disorder, and depression. She partially (amount not stated) breastfed her infant for about 1 month. At 6 months of age, the infant's development was considered to be normal, except for recurrent pneumonia caused by congenital pulmonary airway malformation.
A woman with narcolepsy discontinued methylphenidate during pregnancy, but continued sertraline 100 mg and a prenatal vitamin daily during pregnancy and postpartum. She expressed breastmilk for bottle feeding and her infant was fed breastmilk exclusively until 6 months of age, and was weaned at 7 months. When her infant was 13 weeks old, she resumed methylphenidate 10 mg three times daily. The infant met all growth milestones through 6 months of age.
◉ Effects on Lactation and Breastmilk:Methylphenidate reduces serum prolactin, but no studies have been located as of the revision date on the effect of methylphenidate on milk production. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.
A 15-year-old girl had been receiving methylphenidate 54 mg daily in an osmotic release tablet (OROS) for 2 years. Sertraline was started for depression at 50 mg daily and increased to 100 mg daily along with haloperidol 0.5 mg daily. After 12 weeks of therapy, inattentiveness at school and headaches prompted a change from the OROS product to a modified-release methylphenidate product (brand not specified) at 30 mg daily, then increasing to 50 mg daily. Three days after the increase in dosage, the girl had spontaneous milk flow from both breasts and subsequently had an elevated serum prolactin of 67.7 mcg/L. Methylphenidate and haloperidol were discontinued, but sertraline was continued. One week later, galactorrhea resolved completely. Fifteen days after drug discontinuation, the girl's prolactin level was in the normal range at 19.4 mcg/L.
来源:Drugs and Lactation Database (LactMed)