Valg af hypnotikum og amning (engelsk)
Bemærk at indholdet på denne side er mere end ét år gammel. Indholdet afspejler derfor ikke nødvendigvis IRFs nuværende holdning.
Which hypnotic drug is preferred during lactation?
A woman who delivered a child two days ago has need of a hypnotic for a single day or two. Her GP asks which hypnotic is compatible with breastfeeding.
The Drug Information Center has previous dealt with the issue of zopiclone and lactation and concluded that zoplicone may be used as a hypnotic during lactation. (1)(enclosed). The child would receive a small amount of drug (4.0% of the weight adjusted dose maternal dose). Sedative adverse reactions were unlikely but could not be excluded (1).
The amount of clinical data on zolpidem is somewhat less than for zopiclone. The available data show that even less amounts of this drug compared to zopiclone is transferred into the breast milk. Based on data from five lactating women, less than 0.02% of the administered dose of zolpidem appeared in breast milk, giving a milk:plasma ratio of 0.13. Zolpidem was detectable in milk only in samples taken three hours after a single oral dose. Although there are no data on possible effects of this agent on the nursing infant, the total dose to the child after a single maternal dose of 20 mg was estimated to be less than 4 mcg (about 2 mcg/kg). By contrast, the equivalent adult dose in this study was about 300 mcg/kg, ie the child will receive 0.7 per cent of the weight adjusted maternal dose (2). For both zolpidem and zopiclone, data are laking for the amount of drug in the milk after multiple doses (continued use).
Among hypnotics, zolpidem should be chosen for use during lactation, as less amount of this drug compared to zopiclone is transferred into the milk. For both drugs, the suckling child would receive only a very small amount of the drug and sedative adverse reactions seem not likely, but cannot be excluded. The amount of hypnotics in the milk after multiple doses is unknown, and hypnotics should therefore only be sporadically used during lactation.
The mother should be advised about possible, although unlikely, adverse reactions in the child.
- The Drug Information Center, Odense, Denmark. Case no 1367 (2004)
- 2. Pons G, Francoual C, Guillet P, Moran C, Hermann P, Bianchetti G, Thiercelin JF, Thenot JP, Olive G. Zolpidem excretion in breast milk.
Eur J Clin Pharmacol. 1989;37(3):245-8.
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Response approved by
Institut for Rationel Farmakoterapi, 10. april 2006