กระจกหก ..ยา

ใช้ยานี้ ให้นมได้มั๊ยน้า
http://e-lactancia.org/search?q=Fluoxetine

การใช้ยาในหญิงให้นมบุตร

http://competencyrx.com/index.php?option=com_content&view=article&id=116:2010-06-10-00-25-44&catid=48:2010-03-22-09-59-11&Itemid=101

การจัดแบ่งยาผ่านทางน้ำนม
แบ่งตาม American Academy of Pediatrics Rating (AAP) และ World Health Organization Rating (องค์การอนามัยโลก) ได้เป็นดังนี้คือ
Compatability (C)   หมายถึง สามารถใช้ได้อย่างปลอดภัยในหญิงให้นมบุตร
Incompatability (IC)  หมายถึง ห้ามใช้ในหญิงให้นมบุตร
และในกรณีที่เป็นเครื่องหมาย *  หมายถึง ไม่มีข้อมูลการจัดแบ่งยาผ่านน้ำนมไว้ใน  American Academy of
Pediatrics Rating และ World Health Organization Rating (องค์การอนามัยโลก) แต่เมื่อประเมินด้วย Thomson Lactation Rating ไม่มีรายงานการศึกษาการใช้ยาดังกล่าวในหญิงให้นมบุตร  ควรพิจารณาถึงประโยชน์และความเสี่ยงภายใต้ดุลพินิจของแพทย์

Antibacterials  (beta-lactam drugs)                                 Lactation class
Amoxicillin                                                                               Compatible
Amoxicillin+clavulanic  (Augmentin?)                                Compatible
Ampicillin                                                                                 Compatible
Ampicillin sodium + Sulbactam (Unasyn?)                      Compatible
Cloxacillin                                                                                Compatible
Cephalexine                                                                            Compatible
Cefazolin                                                                                  Compatible
Cefuroxime (Zinnat ?)                                                            Compatible
Ceftazidime                                                                              Compatible
Ceftriaxone                                                                               Compatible
Cefdinir (Omnicef?)                                                                Compatible
Cefditoren (Meiact?)                                                               Compatible
Cefixime (cefspan?)                                                               Compatible
Cefoperazone + sulbactam (sulperazone?)                      Compatible
Imipenem + cilastatin (Tienam?)               Limited human data – Probably Compatible
Meropenem  (Meronem) ?                                                  No human data  
Ertapenem  (Invanz?)                                    Limited human data – Probably Compatible

Quinolone
Norfloxacin                                                      Limited human data-probably Compatible
Ciprofloxacin                                                  Limited human data-probably Compatible
Ofloxacin                                                         Limited human data-probably Compatible
Levofloxacin (Cravit?)                                   Limited human data-probably Compatible
Moxifloxacin (Avelox?)                                  Limited human data-probably Compatible

MacrolideErythromycin                                                                        Compatible
Roxithromycin (Rulid?)                               Limited human data-probably Compatible
Clarithromycin (Klacid?, Crixan?)                                   No human data
Azithromycin (Zithromax?)                                                Compatible

Other antibacterial
Tetracyclin                                                                           Compatible
Doxycyclin                                                Compatible (Avoid if possible (staining infant’s teeth)
Clindamycin (Dalacin C?)                                 Compatible (Avoid if possible)
Metronidazole (Flagyl?)                                      Avoid if possible Limited human data
Chloramphenicol                                                Avoid if possible Limited human data
Trimethoprim-Sulfamethoxazole (Bactrim?)    Compatible (Avoid if possible)
                                                                                   avoided if G6PD-deficient infant

Aminoglycoside   
Gentamycin                                                                        Compatible
Amikacin                                                                             Compatible
Netilmycin                                                                    Limited human data
Streptomycin                                                                      Compatible
Neomycin                                                                     Limited human data

Antiviral drugsAcyclovir                                                                              Compatible
Valacyclovir                                                                        Compatible
Ganciclovir                                                                       No human data
Oseltamivir (Tamiflu?)                                      No human data – probably compatible

Antifungal drugs
Itraconazole (Sporal?)                                        Limited human data-potential toxicity
Fluconazole (Diflucan?)                                                  Compatible
Ketoconazole                                                                    Compatible
Clotrimazole V.T (Fungiderm?)                                     Compatible
Griseofulvin                                                          No human data-potential toxicity
Nystatin                                                                              Compatible

Anthelminthics
Albendazole                                                                               *
Mebendazole                                                     Avoid if possible Limited human data
Praziquantel                                                       Avoid if possible Limited human data

Analgesics
Paracetamol                                                                   Compatible
Morphine                                                          Limited human data – probably compatible
Pethidine                                                         Compatible (Avoid repeated doses if possible)
Tramadol (Tramal?)                                       Limited human data – probably compatible

AntimigraineErgotamine (Cafergot?)                                Limited human data – probably compatible
Zolmitriptan(Zomig?)                                     Limited human data – probably compatible

Antiallergics and drugs used in anaphylaxisDexamethasone                                                           Compatible
Hydrocortisone                                                Limited human data – probably compatible
Prednisolone                                                                 Compatible

Antihistamine
Chlorpheniramine (CPM)                              Limited human data – probably compatible
Diphenhydramine(Benadryl?)                                    Compatible
Hydroxyzine (Atarax?)                                      Limited human data – probably compatible
Doxepine (Sinequan?)                                   Limited human data – probably compatible
Cetirizine (Zyrtec?)                                          Limited human data – probably compatible
Loratadine (Clarityne?)                                               Compatible
Desloratadine (Aerius?)                                 Limited human data – probably compatible
Fexofenadine (Telfast?)                                 Limited human data – probably compatible
Triprolidine/Pseudoephedrine(Actifed?)     Limited human data – probably compatible

Antitussives ; Expectorants
Acetylcysteine (Fluimucil?, Mysoven?, Nac long?)     Compatible
Codeine/Guaifenesin  (Ropect?)                 Limited human data – probably compatible
Dextromethorphan (Romilar?)                                        Compatible
Bromhexine(Bisolvon?)                                                            *
Carbosysteine (Flemex?)                                                         *

Antiasthmatic drugs
Salbutamol (Ventolin?)                                                               *
Theophylline (Theo-dur?)                                                Compatible
Procaterol hydrochloride (Meptin)                                             *
Salmeterol + fluticasone (Seretide?)                                       *
Montelukast sodium (Singulair?)                                   Compatible

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)Diclofenac (Votaren?)                                                       Compatible
Ibuprofen (Brufen?)                                                           Compatible
Mefenamic (Ponstan?)                                                     Compatible
Meloxicam (Mobic?)                                         Limited human data-probably compatible
Piroxicam (Feldene?,Brexin?)                       Limited human data-probably compatible
Naproxen (Synflex?)                                                          Compatible
Indomethacin(Indocid?)                                                   Compatible
Sulindac (Clinoril?)                                            No human data – potential toxicity
Celecoxib (Celebrex?)                                       No human data – potential toxicity
Parecoxib (Dynastat?)                                                   No human data

Dyspepsia
Alum milk (Aluminium + magnesium)                         Compatible
Cimetidine                                                                         Compatible
Simeticone (Air-x?)                                                           Compatible
Ranitidine                                                                           Compatible
Esomeprazole (Nexium?)                                No human data – Potential toxicity
Pantoprazole (Controloc?)                               Limited human data-probably compatible
Lantoprazole (Prevacid?)                                  No human data – Potential toxicity
Rabeprazole (Pariet?)                                       No human data – Potential toxicity
Omeprazole(Miracid?)                                       Limited human data-Potential toxicity
Sucrafate                                                                             Compatible

Anti-emeticDimenhydrinate                                                                 Compatible
Domperidone (Motilium M?)                           Limited human data-probably compatible
Metoclopramide (Plasil?)                                Avoid if possible Limited human data
Ondansetron (Onsia?)                                     Avoid if possible Limited human data
Hyoscine (Buscopan?)                                                    Compatible

Anti –Diarrheals
Loperamide(Imodium?)                                                  Compatible
Diphenoxylate/atropine(Lomotil?)                 Limited human data – potential toxicity
Activated charcoal (Ultracarbon?)                                 Compatible
Dioctahedral smectite (Smecta?)                  No human data-probably compatible

Antispasmodics
Hyoscine-N-butylbromide (Buscopan)                                   *
Mebeverine(Colofac)                                        Avoid if possible Limited human data
Flavoxate (Urispas)                                          Avoid if possible Limited human data

LaxativesBulk-forming laxative Psyllium  (Mucillin?)                                                        Compatible
Macrogol (Forlax?)                                                           Compatible
Stimulant
Senna (Senokot?)                                                            Compatible
Bisacodyl (Dulcolax?)                                      No human data-probably compatible
Castor oil (น้ำมันละหุ่ง)                                     Limited human data-probably compatible
Osmotic laxatives
Glycerin suppositories                                                    compatible
Magnesium Hydroxide (Milk of magnesia?)                compatible
Lactulose (Duphalac?)                                                    Compatible
Lubricants
Mineral oil (Liquid paraffin)                                                      *
Stool softener Docusate sodium                                                              Compatible

Tranquilizers
Diazepam                                          Compatible (single dose , avoid repeated doses if possible)
Alprazolam (Xanax?)                                       Limited human data – potential toxicity
Clonazepam (Rivotril?)                                   Limited human data – potential toxicity

Anticonvulsants/Antiepileptics
Phenobarbital                                                Limited human data-should be given with caution
Phenytoin (Dilantin?)                                                 probably compatible
Valproic acid (Depakin?)                                           probably compatible
Carbamazepine (Tegretol?)                                      probably compatible
Gabapentin (Neurontin?)                                                           *

AntidepressionAmitriptyline                                                  Limited human data – Probably Compatible
Doxepin (Sinequan?)                                        Avoid if possible Limited human data
Duloxetine (Cymbalta?)                                                  Incompatible
Fluoxetine (Prozac?)                                           Avoid if possible Limited human data
Nortriptyline                                                     Limited human data – Probably Compatible
Sertraline (Zoloft?)                                               Avoid if possible Limited human data
Venlafaxine (Efexor XR?)                                    Avoid if possible Limited human data

ตัวอย่างยาที่ห้ามใช้ในขณะให้นมบุตร
Azathioprine
Cyclophosphamide
Methotrexate
Cyclosporin
Asparagenase
Chlorambucil
Cisplatin
Cytalabine
Dactinomycin
Doxorubicin
Etopocide
Fluorouracil
Levamisole
Procabazine
Vincristine
Vinblastine
Tamoxifen
Testosterone

ตัวอย่างยาที่ควรหลีกเลี่ยงในขณะให้นมบุตร
Atenolol
Chloramphenicol
Chlorpheniramine
Chlorpromazine
Cimetidine
Ciprofloxacin
Clindamycin
Ethosuximide
Fluphenazine
Haloperidol
Lithium carbonate
Mefloquine
Methylene blue
Metronidazole
Nalidixic acid
Neostigmine
Potassium iodide
Povidine iodine
Promethazine
Sulfadiazine
Sulfasalazine

Reference
1. Breastfeeding and maternal medication. Department of Child and Adolescent Health and Development,World Health Organization,2003.
2. Weiner CP. Drugs for pregnant and lactating woman. 2nd edition 2009.
3. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 8th edition.
4. การใช้ยาของสตรีระหว่างให้นมบุตร .ภญ. นันทวรรณ กิติกรรณากรณ์. ฟาร์มาไทม์ มกราคม 2550.
5. การใช้ยาในขณะให้นมบุตร. ภก.ดร. วิวรรธน์ อัครวิเชียร .วารสารสมาคมเภสัชกรรมชุมชน(ประเทศไทย