DEFINITION

Almost all the medicines go on in certain grade to the maternal milk, but the meaning of this fact on the nursing one depends of:

• the grade of step of the medicine to the milk

• the quantity of milk consumed by the nursing one in every capture

• if the quantity consumed in every capture is the same

• the frequency of the captures

• if the medicine is absorbed by the nursing one

• if the nursing one is affected by the medicine.

Problems exist to determine what medicines are contra-indicated in the mothers who nurse his children, due to the very limited studies in the man. The information often is obtained of reports on cases with a very small number of individuals or of anecdotal reports on adverse effects in nursing fed to the breast that they collaborate to the medicines that the mother takes.

But it is thought that, unless a medicine should be highly powerful and an enclosed toxicant to very low concentrations, or should have accumulative effects in the nursing ones due to the immaturity of his metabolism and elimination, the excretion of the medicine in the milk does not have why to represent an important danger for the nursing ones.

CONTRAINDICATIONS

They are contra-indicated of absolute form (breast feeding impossibility in case of needing) the following medicines:

• Anti-cancer
• Radiofármacos
• Ergotamina and his derivatives (metisergida, etc.) used in migraines
• Lithium (antidepressant)
• Cloramfenicol and tetraciclinas (antibiotics)
• (Analgesic - anti-inflammatory) Fenilbutazona
• Atropina (anticolinérgico)
• (Antithyroid) Tiouracilo
• (Anti-cough-suppressant) Yoduros
• Mercurial (diuretics)

MEDICINES OF FREE SALE

They must be born more and in mind, due to his availability for the consumers and to the increasing tendency to the autodiagnosis and to the treatment of the small autolimited illnesses. Between they are included:
(1) analgesics, like acid acetilsalicílico, ibuprofeno and paracetamol;
(2) antihistamines contained in prepared for the cold, the sinusitis and the cough, in the destined ones to fight the dizziness and in the sleeping pills;
(3) simpaticomiméticos, like ephedrine, pseudoephedrine, fenilefrina and fenilpropanolamina, used selectively in the prepared anticongestive ones, anorexígenos and antiasthmatic;
(4) antacid, laxative and cathartic;
(5) prepared topics (cutaneous, rectal and vaginal), which include corticoids, anesthetic places, astringents (zinc, bismuth), etc.

In general, all the said medications are relatively sure for the mothers who nurse his children if they take during a little time and in the doses prescribed in the brochures. In the medicines of free sale the least poisonous are used, to the minimal effective therapeutic doses.

MEDICINES OF MEDICAL PRESCRIPTION

• Analgesics. The salicilatos and the paracetamol seem sure to therapeutic doses. For the ibuprofeno he does not get ready of information. The analgesic opiates (p. ej., codeine, morphine, meperidina or methadone), to the only therapeutic doses, they are excreted in the milk in very low concentrations that scarcely affect the nursing ones. Nevertheless, the mothers addicted to the opiates should never nurse his children.
• Antibiotics. They can be taken by the mothers who nurse his children without important risks for these. Nevertheless, since almost all the antibiotics are excreted in the milk, the nursing ones can develop hypersensitivity, diarrhea and sobreinfecciones for fungi. The tetraciclinas (p. ej., minociclina, doxiciclina) they must be avoided in the mothers who nurse his children.
• The antihypertensive ones, the diuretics, the digoxina and the blockers b-adrenérgicos can be prescribed of continued form without important adverse effects taking place in the nursing ones.
• The contraceptive preferable oral ones are to low doses and of the only hormone.
• The corticoids, if the mother is administered in big doses and during long periods, can reach concentrations raised in the milk with the consequent risk of inhibiting the growth of the nursing one.
• The diazepam and sedative others are excreted by the maternal milk and they produce litany, drowsiness and loss of weight in the children fed to the breast.

High doses of alcohol, caffeine and teofilina they can be harmful to the nursing one

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