Drugs and Human Lactation Second Edition This Page Intentionally Left Blank Drugs and Human Lactation Second Edition A comprehensive guide to the content and consequences of drugs, micronutrients, radiopharmaceuticals and environmental and occupational chemicals in human milk Editor: Peter N Bennett Co-authors: Margaret C Neville Lidia J Notarianni Ann Prentice Anders Rane Dietrich Reinhardt Carol T Walsh Allan Astrup-Jensen Christopher J Bates Evan J Begg Susan Edwards Colin R Lazarus Ingrid Matheson Peter J Mountford 1996 ELSEVIER Amsterdam - Lausanne - New York - Oxford - Shannon - Tokyo 1996 Elsevier Science B.V All rights reserved No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher, Elsevier Science BV, Copyright and Permissions Department, P.O Box 521, 1000 AM Amsterdam, The Netherlands The right of Dr Peter Bennett and the other contributors to be identified as the author of the work has been asserted by them in accordance with the Copyright, Design and Patents Act 1988 in the United Kingdom, and with similar legislation in other jurisdictions The authors and publishers have, so far as is possible, taken care to ensure that the text of this book accurately reflects knowledge of the area covered at the time of publication The possibility of human error is acknowledged, however, and neither the authors nor the publishers guarantee that the information contained in the book is accurate and complete in every respect The principles and methodology which underlie the advice about individual substances is contained within relevant chapters It is assumed that such advice will always be interpreted in the light of the circumstances that relate to individual cases Furthermore, medical science, and in particular medicinal therapeutics, is ever increasing and changing and readers are encouraged to confirm the information in this book from other and current sources We hope, nevertheless, that the approaches outlined in the book will be helpful in interpreting such new information No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein Because of the rapid advances in the medical sciences, the publisher recommends that independent verification of diagnoses and drug dosages should be made Special regulations for readers in the U.S.A.: This publication has been registered with the Copyright Clearance Center Inc (CCC), 222 Rosewood Drive, Danvers, MA 01923 Information can be obtained from the CCC about conditions under which the photocopying of parts of this publication may be made in the U.S.A All other copyright questions, including photocopying outside of the U.S.A., should be referred to the copyright owner, Elsevier Science BV, unless otherwise stated ISBN 444 81981-9 Library of Congress C a t a l o g i n g - i n - P u b l i c a t i o n Data Drugs and human l a c t a t i o n : a c o m p r e h e n s i v e g u i d e to the c o n t e n t and consequences o f d r u g s , m i c r o n u t r i e n t s , radiopharmaceuticals, and e n v i r o n m e n t a l and o c c u p a t i o n a l c h e m i c a l s In human m i l k / e d i t o r , P e t e r N B e n n e t t ; c o - a u t h o r s , Allan Astrup-Jensen let al.] -2nd ed p cm Includes bibliographical r e f e r e n c e s and i n d e x ISBN - 4 - - ( a l k p a p e r ) B r e a s t f e e d i n g - - H e a l t h aspects B r e a s t m i l k - - C o n t a m i n a t i o n I n f a n t s (Newborn) Effect of d r u g s on I B e n n e t t , P N [DNLM: L a c t a t i o n - - d r u g effects M l l k , Human drug e f f e c t s WP 825 D7936 1996] RJ216.D69 1996 613.2'69 dc21 DNLM/DLC 96-38943 for Library of Congress CIP Printed in The Netherlands on acid-free paper List of contributors PETER N BENNETT', M.D., F.R.C.P School of Postgraduate Medicine University of Bath Wolfson Centre Royal United Hospital Combe Park Bath BA1 3NG United Kingdom ALLAN ASTRUP-JENSEN, Ph.D DK-Teknik Energy & Environment 15 Gladsaxe Mr DK-2860 SCborg Denmark COLIN LAZARUS, Ph.D Department of Nuclear Medicine Guy's Hospital St Thomas Street London SE1 9RT United Kingdom INGRID MATHESON, Ph.D Department of Pharmacotherapeutics University of Oslo Postboks 1065 Blindern 0316 Oslo Norway CHRISTOPHER J BATF_S,M.A., D.Phil MRC Dunn Nutrition Unit Downham' s Lane Milton Road Cambridge CB4 1KJ United Kingdom PETER J MOUNTFORD, Ph.D Department of Biomedical Engineering and Medical Physics North Staffordshire Hospital Princes Road Hartshill Stoke on Trent ST4 7LN United Kingdom EVAN J BEGG, M.B.Ch.B,F.R.A.C.P Clinical Pharmacology Christchurch Hospital Private Bag 4710 Christchurch New Zealand MARGARET C NEVILLE, Ph.D Department of Physiology University of Colorado Health Sciences Center Denver, CO 80262 USA SUSAN EDWARDS, B.Sc Women, Children and Families Directorate Essex County Hospital Lexden Road Colchester CO3 3NB United Kingdom LIDIA J NOTARIANNI, M.Sc.,Ph.D School of Pharmacy and Pharmacology University of Bath Claverton Down Bath BA2 7AY United Kingdom ANN PRENTICE, D.Phil MRC Dunn Nutrition Unit Downham's Lane Milton Road Cambridge CB4 1KJ United Kingdom DIETRICH REINHARDT, M.D Kinderpoliklinik Universit~it Mtinchen Pettenkoferstrasse 8a 80336 Mtinchen Germany ANDERS RANE, M.D., Ph.D Department of Clinical Pharmacology University Hospital S-751 85 Uppsala Sweden CAROL WALSH, Ph.D Department of Pharmacology Boston University School of Medicine 80 E Concord Street Boston, MA 02118-2394 USA vi Preface In 1985 the European Office of the World Health Organization called toge.ther a group of experts with the remit of evaluating and rationalising the rather confused literature on the dangers, real and perceived, of substances in human milk Over the next two years the WHO Group met in Copenhagen, Bath, Oslo and, memorably, amid the pine and birch trees of a more remote part of Norway, and developed principles for assessing reports and allocating levels of risk for breast-feeding mothers These principles and their application to the current literature oxx drugs, radiopharmaceuticals, micronutrients and pollutants comprised the first edition of this book, which appeared in 1988 It is a pleasure to record the contribution of the European Office of WHO and in particular Graham Dukes in overseeing the original project In addition, the first edition owed a great deal to the input of Chris van Boxtel, Elisabet He!sin~ PerKnut Lunde, Michael Orme, John Philip, Hans Seyberth, Paivi Soderman and John Wilson; although they are not participating in the new edition, their part i~ the development of the methodology for the book and its application to individua! substances is gratefully acknowledged This second edition welcomes the contributions of Evan Begg, Peter Mou~,~tford, Margaret Neville and Carol Walsh New material has been analysed according to the methods established for the first edition, bringing the various subject-areas up to date The book remains what its sub-title claims: a comprehensive g,~ide to the content and consequences of substances in milk We hope it will c