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Breastfeeding Moms Breastfeeding Moms

Heart meds... HELP PLEASE!!!!!!

Posted by on Oct. 26, 2013 at 7:15 PM
  • 10 Replies
Does anyone have any experience taking cardizem while nursing? Lactmed says its safe then another article says this...

Sustained-release nifedipine (Procardia XL) and verapamil (Calan SR) are excreted into breast milk in amounts that are less than the therapeutic dosage for children. Although diltiazem (Cardizem CD) is rated compatible with breast-feeding by the AAP, the levels found in breast milk are higher than the levels for other calcium channel blockers, so safer alternatives are preferred.3,6 Captopril (Capoten) and enalapril (Vasotec) are excreted into breast milk in small amounts. These medications are rated compatible with nursing by the AAP, although they have been studied less than other alternatives.3,6 Because neonates are highly sensitive to the effects of angiotensin-converting enzyme (ACE) inhibitors, their use by breast-feeding mothers in the first month of their infants' lives may be of concern.7 Hydralazine (Apresoline) is excreted in amounts far less than the pediatric dosage and is safe, especially for short-term use following delivery.3,6

I've had different drs tell me different things. I'm so scared And confused :-(

My baby is 2m old today and just under 10lbs.
by on Oct. 26, 2013 at 7:15 PM
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gdiamante
by Group Mod - Gina on Oct. 26, 2013 at 7:28 PM
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I tend to go with LactMed and never with the info provided by the manufacturer. Manufacturer info tends to have more to do with the legal department than actual medicine. (My prenatals carried the warning, "NOT TO BE TAKEN BY PREGNANT WOMEN." I've never read a package insert warning since that day.)

And doctors look at the manufacturer info.

LactMed gives Cardizem the OK.

maggiemom2000
by Ruby Member on Oct. 26, 2013 at 7:32 PM

It looks to me like nifedipine would be the preferred drug for breastfeeding moms, but breastfeeding while on this med would still be less risky than formula feeding.

The decision about continuing breastfeeding when the mother takes a drug is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother and the baby. And there are plenty of risks in not breastfeeding, so the question essentially boils down to:  Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than exclusive formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. Dr, Jack Newman http://www.breastfeedinginc.ca/content.php?pagename=doc-B-M

The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2012.  He assigns every drug a lactation risk category:  L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. Possible risks to mother and baby are listed as well as possible effect on milk supply.


For more info you can call Dr. Hale’s InfantRisk hotline at (806) 352-2519

www.infantrisk.org


DILTIAZEM (Cardizem SR, Dilacor-XR, Cardizem CD, Cartia XT

Listed as L3, moderately safe; pediatric concerns: Hypotension, bradycardia is possible. See nifedipine

“Diltiazem hydrochloride is an typical calcium channel blocker antihypertensive. In a report of a single patient receiving 240 mg/day on day 14 postpartum, levels in milk were parallel to those of serum (milk/plasma ratio is approximately 1.0) Peak level in milk (and plasma) was slightly higher than 200ug/L and occured at 8 hours. While nifedipine is probably a preferred choice calcium channel blocker because of our experience with it, the relative infant dose with this agent is quite small and it is not likely to be problematic.”

echupko
by Bronze Member on Oct. 26, 2013 at 7:42 PM
The cardiologist only wants me to take 30mg 4x a day. A much smaller dosage than this study. I wonder of that makes a difference. I'll bring it up to the cardiologist Monday avd ask about the other meds.

Breaatfeeding is VERY important to me. I can NOT not nurse my last baby and my first daughter. I want to give her years like I did with her 3 brothers


Quoting maggiemom2000:

It looks to me like nifedipine would be the preferred drug for breastfeeding moms, but breastfeeding while on this med would still be less risky than formula feeding.

The decision about continuing breastfeeding when the mother takes a drug is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother and the baby. And there are plenty of risks in not breastfeeding, so the question essentially boils down to:  Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than exclusive formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. Dr, Jack Newman http://www.breastfeedinginc.ca/content.php?pagename=doc-B-M

The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2012.  He assigns every drug a lactation risk category:  L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. Possible risks to mother and baby are listed as well as possible effect on milk supply.




For more info you can call Dr. Hale’s InfantRisk hotline at (806) 352-2519


www.infantrisk.org


DILTIAZEM (Cardizem SR, Dilacor-XR, Cardizem CD, Cartia XT

Listed as L3, moderately safe; pediatric concerns: Hypotension, bradycardia is possible. See nifedipine



“Diltiazem hydrochloride is an typical calcium channel blocker antihypertensive. In a report of a single patient receiving 240 mg/day on day 14 postpartum, levels in milk were parallel to those of serum (milk/plasma ratio is approximately 1.0) Peak level in milk (and plasma) was slightly higher than 200ug/L and occured at 8 hours. While nifedipine is probably a preferred choice calcium channel blocker because of our experience with it, the relative infant dose with this agent is quite small and it is not likely to be problematic.”

maggiemom2000
by Ruby Member on Oct. 26, 2013 at 8:11 PM

Yes, the dose does make a difference, as does the age of your baby. Since Dr Hale felt that this case, with a much higher dose and a younger baby is safe, then your situation would be even safer.

If the other meds, like the procardia, would be just as good for your health, then that may be better. It is not necessarily safer, just more studied.

Quoting echupko:

The cardiologist only wants me to take 30mg 4x a day. A much smaller dosage than this study. I wonder of that makes a difference. I'll bring it up to the cardiologist Monday avd ask about the other meds.

Breaatfeeding is VERY important to me. I can NOT not nurse my last baby and my first daughter. I want to give her years like I did with her 3 brothers


Quoting maggiemom2000:

It looks to me like nifedipine would be the preferred drug for breastfeeding moms, but breastfeeding while on this med would still be less risky than formula feeding.

The decision about continuing breastfeeding when the mother takes a drug is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother and the baby. And there are plenty of risks in not breastfeeding, so the question essentially boils down to:  Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than exclusive formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. Dr, Jack Newman http://www.breastfeedinginc.ca/content.php?pagename=doc-B-M

The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2012.  He assigns every drug a lactation risk category:  L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. Possible risks to mother and baby are listed as well as possible effect on milk supply.




For more info you can call Dr. Hale’s InfantRisk hotline at (806) 352-2519


www.infantrisk.org


DILTIAZEM (Cardizem SR, Dilacor-XR, Cardizem CD, Cartia XT

Listed as L3, moderately safe; pediatric concerns: Hypotension, bradycardia is possible. See nifedipine



“Diltiazem hydrochloride is an typical calcium channel blocker antihypertensive. In a report of a single patient receiving 240 mg/day on day 14 postpartum, levels in milk were parallel to those of serum (milk/plasma ratio is approximately 1.0) Peak level in milk (and plasma) was slightly higher than 200ug/L and occured at 8 hours. While nifedipine is probably a preferred choice calcium channel blocker because of our experience with it, the relative infant dose with this agent is quite small and it is not likely to be problematic.”


IrishIz
by Silver Member on Oct. 26, 2013 at 9:41 PM
Hale...

PROBABLY SAFE. Human studies in breastfeeding women are not available or if available demonstrate only minimal to no adverse effects. Levels in milk are generally low. While nifedipine is probably a preferred choice calcium channel blocker because of our experience with it, the relative infant dose with this agent is quite small and it is not likely to be problematic.

For more information, contact the InfantRisk Center at (806)352-2519
echupko
by Bronze Member on Oct. 27, 2013 at 1:11 AM
Thanks

Quoting maggiemom2000:

Yes, the dose does make a difference, as does the age of your baby. Since Dr Hale felt that this case, with a much higher dose and a younger baby is safe, then your situation would be even safer.

If the other meds, like the procardia, would be just as good for your health, then that may be better. It is not necessarily safer, just more studied.

Quoting echupko:

The cardiologist only wants me to take 30mg 4x a day. A much smaller dosage than this study. I wonder of that makes a difference. I'll bring it up to the cardiologist Monday avd ask about the other meds.



Breaatfeeding is VERY important to me. I can NOT not nurse my last baby and my first daughter. I want to give her years like I did with her 3 brothers




Quoting maggiemom2000:

It looks to me like nifedipine would be the preferred drug for breastfeeding moms, but breastfeeding while on this med would still be less risky than formula feeding.

The decision about continuing breastfeeding when the mother takes a drug is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother and the baby. And there are plenty of risks in not breastfeeding, so the question essentially boils down to:  Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than exclusive formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. Dr, Jack Newman http://www.breastfeedinginc.ca/content.php?pagename=doc-B-M

The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2012.  He assigns every drug a lactation risk category:  L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. Possible risks to mother and baby are listed as well as possible effect on milk supply.






For more info you can call Dr. Hale’s InfantRisk hotline at (806) 352-2519



www.infantrisk.org


DILTIAZEM (Cardizem SR, Dilacor-XR, Cardizem CD, Cartia XT

Listed as L3, moderately safe; pediatric concerns: Hypotension, bradycardia is possible. See nifedipine





“Diltiazem hydrochloride is an typical calcium channel blocker antihypertensive. In a report of a single patient receiving 240 mg/day on day 14 postpartum, levels in milk were parallel to those of serum (milk/plasma ratio is approximately 1.0) Peak level in milk (and plasma) was slightly higher than 200ug/L and occured at 8 hours. While nifedipine is probably a preferred choice calcium channel blocker because of our experience with it, the relative infant dose with this agent is quite small and it is not likely to be problematic.”


echupko
by Bronze Member on Oct. 27, 2013 at 1:12 AM
Thank you

Quoting IrishIz:

Hale...



PROBABLY SAFE. Human studies in breastfeeding women are not available or if available demonstrate only minimal to no adverse effects. Levels in milk are generally low. While nifedipine is probably a preferred choice calcium channel blocker because of our experience with it, the relative infant dose with this agent is quite small and it is not likely to be problematic.



For more information, contact the InfantRisk Center at (806)352-2519
aehanrahan
by Group Mod - Amy on Oct. 27, 2013 at 1:44 AM
I always go by what Dr. Hale says. ^^^
You can call the infantrisk hotline that is listed above and ask about your dosage. As maggiemom2000 said, the lower dose will be safer than what it talks about in the listing.
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echupko
by Bronze Member on Oct. 27, 2013 at 5:06 AM
I going to call first thing Monday morning.

I can believe I'm having to even think about all this :-( life can be turned upside down in an instant...

Quoting aehanrahan:I always go by what Dr. Hale says. ^^^
You can call the infantrisk hotline that is listed above and ask about your dosage. As maggiemom2000 said, the lower dose will be safer than what it talks about in the listing.
Cruz-s-mommy
by Amanda on Oct. 27, 2013 at 10:05 PM
1 mom liked this
I agree with others. I was told to stop BFing Cruz when he was younger because I have an autoimmune disorder and had to be on "unsafe" meds the doctor was practically yelling at me to stop nursing, but I did my research: lactmed, infant risk hotline, this group ;-) and understood that it was in fact safe and better than he would have been if weaned. He is 26 months and still nursing, I have been on other meds and he's never been negatively affected by them either. Good luck, don't worry, I'm sure you'll be able to safely continue nursing without a hitch! :-)
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