毒理性
◉ 母乳喂养期间使用总结：有限的数据表明，左旋多巴进入母乳的情况较差，并且与即释产品相比，缓释产品可能导致转移到哺乳婴儿的药物量更少。几项研究表明，左旋多巴可以降低哺乳期间的血清催乳素水平。对于已经建立哺乳的母亲来说，催乳素水平可能不会影响她的哺乳能力。尽管一些母亲在使用相对低剂量的左旋多巴和卡比多巴治疗帕金森病的同时，能够成功地哺乳而没有明显的伤害，但长期使用左旋多巴对哺乳的影响尚未得到充分评估。
◉ 对哺乳婴儿的影响：一名患有帕金森病的母亲服用了缓释左旋多巴200毫克和卡比多巴50毫克，每日四次。她成功地哺乳了她的婴儿，婴儿在2岁时的发展是正常的。
一名37岁的以色列妇女在服用20毫克/毫升左旋多巴和5毫克/毫升卡比多巴凝胶的持续输注期间怀孕。她在接受药物治疗的同时哺乳了3个月的婴儿，尽管从论文中不清楚哺乳的程度和凝胶的剂量。在10个月大时，婴儿的心理运动发展被认为是正常的。
◉ 对泌乳和母乳的影响：左旋多巴会降低正常女性和患有高催乳素血症的女性的血清催乳素水平，并且可以在乳汁分泌过多的情况下抑制不当的泌乳，尽管并不一致。对于已经建立哺乳的母亲来说，催乳素水平可能不会影响她的哺乳能力。
一名患有帕金森病的母亲服用了缓释左旋多巴200毫克和卡比多巴50毫克，每日四次。她成功地哺乳了她的婴儿。
在分娩后第3天，5名妇女单次口服了500毫克左旋多巴或5毫克溴隐亭，随后在3小时后单次口服了10毫克甲氧氯普胺。溴隐亭比左旋多巴更能抑制基础血清催乳素。在接下来的3小时内，接受左旋多巴的患者在服用甲氧氯普胺后血清催乳素升高，而接受溴隐亭的患者则没有升高。
6名分娩后2到4天但未哺乳的妇女在一天内口服了500毫克左旋多巴，在接下来的一天内口服了100毫克左旋多巴加上35毫克卡比多巴。两种方案都抑制了基础血清催乳素水平。然而，单独使用左旋多巴导致催乳素降低了78%，而较低剂量的组合仅导致催乳素降低51%。两种方案在服用剂量后约2小时达到最大效果。
在分娩后第一周，正在大约每天哺乳7次的7名妇女服用了500毫克口服左旋多巴，并研究了她们的血清催乳素反应。第二天，她们开始每6小时口服50毫克卡比多巴，持续2天。在第三天，她们接受了单次口服卡比多巴50毫克加左旋多巴125毫克的剂量。在服用左旋多巴后30分钟和组合用药后45分钟，基础血清催乳素降低。在服用剂量后120分钟达到最大降低，单独使用左旋多巴降低62%，使用组合降低48%，尽管两种方案之间的差异在统计学上并不显著。
一名37岁的以色列妇女在服用20毫克/毫升左旋多巴和5毫克/毫升卡比多巴凝胶的持续输注期间怀孕。她在接受药物治疗的同时哺乳了3个月的婴儿，尽管从论文中不清楚哺乳的程度和凝胶的剂量。
◉ Summary of Use during Lactation:Limited data indicate that levodopa is poorly excreted into breastmilk and that the sustained-release product may result in a smaller amount of drug transferred to the breastfed infant than with the immediate-release product. Several studies indicate that levodopa can decrease serum prolactin during lactation. The prolactin level in a mother with established lactation may not affect her ability to breastfeed. The effect of long-term use of levodopa on breastfeeding has not been adequately evaluated, although some mothers were able to successfully breastfeed her infant without apparent harm while using relatively low doses of levodopa and carbidopa for Parkinson's disease.
◉ Effects in Breastfed Infants:One mother with Parkinson's disease took sustained-release levodopa 200 mg and carbidopa 50 mg 4 times daily. She successfully breastfed her infant whose development was normal at 2 years of age.
A 37-year-old Israeli woman with Parkinson's disease became pregnant while taking a continuous infusion of levodopa 20 mg/mL and carbidopa 5 mg/mL gel. She breastfed her infant for 3 months while receiving the drug, although the extent of breastfeeding and the dosage of the gel is not clear from the paper. At 10 months of age, the infant's psychomotor development was deemed to be normal.
◉ Effects on Lactation and Breastmilk:Levodopa decreases serum prolactin in normal women and those with hyperprolactinemia and can suppress inappropriate lactation in galactorrhea, although not consistently. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
One mother with Parkinson's disease took sustained-release levodopa 200 mg and carbidopa 50 mg 4 times daily. She successfully breastfed her infant.
On postpartum day 3, 5 women were given a single oral dose of 500 mg of levodopa or bromocriptine 5 mg followed by a single oral dose of metoclopramide 10 mg 3 hours later. Bromocriptine suppressed basal serum prolactin to a greater extent than levodopa. Over the next 3 hours, serum prolactin increased after metoclopramide in the patients who received levodopa, but not in those who received bromocriptine.
Six women who were 2 to 4 days postpartum, but were not nursing, were given 500 mg of levodopa orally on one day and 100 mg of levodopa plus 35 mg of carbidopa orally on the next day. Both regimens suppressed basal serum prolactin levels. However, levodopa alone caused an 78% decrease in prolactin while the lower dose combination produced only a 51% decrease. The maximal effect occurred about 2 hours after the dose with both regimens.
Seven women in the first week postpartum who were breastfeeding about 7 times daily were given levodopa 500 mg orally and their serum prolactin responses was studied. The following day, they started carbidopa 50 mg orally every 6 hours for 2 days. On the third day, they received a single dose of carbidopa 50 mg plus levodopa 125 mg orally. Decreases in basal serum prolactin occurred by 30 minutes after the levodopa and after 45 minutes with the combination. Decreases were maximum at 120 minutes after the dose and were 62% with levodopa alone and 48% with the combination, although the difference between the 2 regimens was not statistically significant.
A 37-year-old Israeli woman with Parkinson's disease became pregnant while taking a continuous infusion of levodopa 20 mg/mL and carbidopa 5 mg/mL gel. She breastfed her infant for 3 months while receiving the drug, although the extent of breastfeeding and the dosage of the gel is not clear from the paper.
来源:Drugs and Lactation Database (LactMed)
