The American Academy of Pediatrics AAP. Crohn s disease lymphoma

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1 T P N : The American Academy ofpediatrics AAP Crohn s diseaselymphoma

2 pharmacokinetics) free, active unbound drugs 3% 5%emulsified fat 800 daltons NSAID Teratogenicity Risks of Drugs,TRD warfarintrdx (Milk/plasma Ratio ) 1.

3 2. 75% M/P ratio The exposure index Milk/plasma Ratio 10% clinically unimportant ASA G-6PD ANTIDEPRESSANT SSRI ANXIOLYTIC AND SEDATIVE DRUGS BDZ BDZ A review of the excretion and relative infant doses of BZD via breast milk has been reported (Chishom & Killer, 1997): Drug Daily infant dose as a percentage of maternal dose Alprazolam 9.53 Clonazepam Diazepam 9.5 Flunitrazepam 1 Lorazepam 5-10 Lormetazepam 0.35 Oxazepam 0.1 Quazepam 2.3 ANTIPSYCHOTIC DRUGS

4 chlorpromazine(cpz) haloperidol(halo) Llewellyn & Stowe, 1998; Chisholm & Kuller, 1997; Buist et al, 1990): DRUG CASES DOSE PLASMA CONC MILK CONC MILK/ PLASMA RATIO HALO 1 20 NR 5 - HALO * 21* 0.64 CPZ 4 NR FLUP * 3.2* 0.86 CLOP * 13.2* 0.85 FLUP 5 VAR* CLOP 6 VAR** CLOZ >= 2.5 CPZ = chlorpromazine; CLOP = clopenthixol (either isomeric mix or pure cis isomer); FLUP = cis(z)- flupenthixol; HALO = haloperidol ; CLOZ = clozapine,* = average value over several days,** = data were obtained from several patients,plasma/milk concentration (ng/ml) VAR = various doses NSAID ASA ANALEGESIC AGENT Meperidine morphine (neurobehavioral) oxycodone 10% morphine AcetaminophenNSAID ANTICOAGULANT AGENTS vitamin K antagonist warfarinaccenocoumaralhepar, phenindione. ANTIEPILEPTIC AGENTS phenobarbital, ethosuximide,primidone 10% carbamazepine, phenytoin, and valproic acid ANTIMICROBIALl AGENTS chloramphenicol tetracycline Chloramphenicol idiosyncratic aplastic anemia tetracycline discoloration of the teeth ANTICANCER AGENTS (e.g. cyclophosphamide, MTX, doxorubicin) CV and ANTIHYPERTENSIVE AGENTS Acebutolol, amiodarone, atenolol, nadolol, sotalol Propranolol and labetalol ENDOCRINE DRUG /HORMONES Estrogens bromocriptine

5 Oral contraceptives estrogen RESPIRATORY DRUGS Theophylline 10% RADIOACTIVE COMPOUND Ergotamine ergonovine methylergonovine AAP Drugs listed as compatible with breastfeeding by the AAP Acetaminophen Captopril Acyclovir Atropine Baclofen Caffeine Carbamazepine Cephalosporins Cimetidine Clindamycin Codeine Digoxin Diltiazem Enalapril Erythromycin Ethosuximide Hydralazine Ibuprofen Minoxidil Naproxen Methyldopa Nifedipine Penicillins Phenytoin Prednisone Propoxyphene Propylthiouracil Pseudoephedrine Quinidine Quinine Rifampin Senna Spironolactone Tolbutamide Trimethoprim Valproic acid Verapamil Warfarin *Compatibility does not indicate that a drug is risk-free in breastfeeding dyads; it suggests only that, in most situations, there is sufficient evidence to imply safety Drugs contraindicated during breastfeeding Bromocriptine Cyclophosphamide *Cyclosporine Doxorubicin Ergotamine Lithium Methotrexate Radiopharmaceuticals ALL DRUGS OF ABUSE, INCLUDING: Amphetamine Lysergic acid diethylamide (LSD) Cocaine Phencyclidine (PCP) Heroin Excessive nicotine and alcohol *Literature exists suggesting no adverse effects in infants breastfed by mothers taking this medication

6 Additional drugs having significant evidence* for safety in breastfeeding dyads Albuterol inhalers Amantadine Azathioprine Azithromycin Beclomethasone inhaler Budesonide inhalers Bupropion SR Cholera vaccine Cholestyramine Chondroitin sulfate Clomipramine Clotrimazole Cromolyn sodium Cyclosporine Enoxaparin Famotidine Docusate Fluconazole Fluticasone inhaler Hepatitis A vaccine Influenza vaccine Insulin Fluvoxamine Glucosamine Heparin Ipratropium inhaler Levothyroxine Loratadine Metoclopramide Nortriptyline Nystatin Olsalazine Omeprazole Ondansetron Paroxetine Pyrantel pamoate Ranitidine Sertraline Sulfamethoxazole Sumatriptan succinate Troglitazone Zafirlukast *Case report data, pharmacokinetic properties, and/or pediatric use data Resource Medications and Mothers Milk (1999) Thomas W. Hale, R.Ph., Ph.D. Drugs in Pregnancy and Lactation (1998) G.G. Briggs, B.Pharm.; R.K. Freeman, M.D.; S.J. Yaffe, M.D. The Transfer of Drugs and Other Chemicals Into Human Milk. AAP Committee on Drugs: R.E. Kauffman, M.D., Ph.D., Chairperson (1994) nternational Lactation Consultants Association: 4101 Lake Boone Trail, Suite 201 IRaleigh, NC Tel.: (919) Type Revised annually, this pocket reference has on-line updates available at Textbook updated every four years, with quarterly updates by newsletter subscription Policy statement published in Pediatrics Vol. 93, No. 1, January 1994, pp This and other valuable statements/information on breastfeeding are available on-line. Professional organization and publishers of Journal of Human Lactation Source of referrals to lactation consultants Academy of Breastfeeding Medicine Physicians dedicated to the promotion protection, and support of breastfeeding La Leche League International and the Center Nonprofit organization offers numerous for Breastfeeding InformationP.O. Box 4079 publications and opportunities for both Schaumburg, IL 60168www.lalecheleague.org professional and lay instruction in breastfeeding management Accredited volunteer leaders offer mother-to-mother support.

7 X Activelle 1/0.5 mg tab Estradiol hemihydrate 1mg, norethisterone acetate 0.5mg Cafergot tab Ergotamine Tartrate, Caffeine Lactation:- D Divina tab Estradiol, Medroxyprogesterone Lactation:- Estandron 1ml inj Estradiol, Testosterone Evista 60mg tab Raloxifene Lactation:- Gonal-F 75IU Pregnyl 5000IU inj HCG 5000 IU Premelle 2.5 tab Conjugated Estrogen mg, medroxyprogesterone acetate 2.5 mg

8 Premelle Cylce 5 tab Conjugated Estrogens /medroxyprogesterone S Lactation +Generally accepted as safe.?safety unknown or controversial. -Generally regarded as unsafe. Pregnancy risk category ASafety has been established using human studies. BPresumed safety based on animal studies. CUncertain safety-animal studies show an adverse effect, no human studies. DUnsafe-evidence of risk that may in certain clinical circumstance be justifiable. XHighly unsafe risk of use outweighs any possible benefit. Note: +Generally accepted as safe.?safety unknown or controversial. -Generally regarded as unsafe. Micromedex

Palliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers

Palliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers Important Notes: Last Updated: May 11, 2015 Pharmacists must submit a claim on PharmaNet at the time of purchase to enable coverage.