美国儿科学会：哺乳期用药

当哺乳母亲处于诊断阶段或药物治疗阶段时，有关其母乳喂养的建议都应在母婴双方的利益和婴儿接触药物的潜在危险之间作出权衡。只有一部分的药物是被禁止用于哺乳女性的，而且通常可以找到合适的替代品。在由美国国立医学图书馆和美国国立卫生研究院发布的名为LactMed的网络数据库中，提供了关于哺乳女性安全用药的最新最全面的信息资料。美国儿科学会也即将发布有关药物及其他化学物质转移到母乳中的政策陈述，其中将提供补充建议，特别关注于精神药物、草药、催乳剂、麻醉剂和止痛药。一般而言，当母亲在使用以下药物时不建议母乳喂养：安非他命（苯丙胺）、化疗药品、麦角胺和他汀类药物。 许多用于孕哺期的精神药物并没有关于在母乳和/或哺乳后婴儿血液中浓度的充分药理数据。此外，也缺少关于在婴儿早期的重要生长阶段与这些药物接触后的长期神经反应方面的数据。最近一篇全面的评论文章提到，在总共96种精神药物中，只有62种（占65%）的药品有药理学和临床学的信息数据，而只有19种药品有充分信息可供制定安全的医疗方案，因此适合用于哺乳妈妈。以下药物被认为是问题最少的：三环类抗抑郁症药——阿米替林和氯米帕明，以及选择性羟色胺再摄取抑制剂——帕罗西汀和舍曲林。 有关母体在接触诊断放射性物质后暂停哺乳的必要性和间隔时间长短，美国核管理委员会和一些医学评论提供了详细的指导意见。此外，当哺乳婴儿患有葡萄糖-6磷酸脱氢酶缺乏症时，应当实施特别的预防措施。妈妈应当避免服用蚕豆、呋喃妥因、伯氨喹（抗疟药物）和非那吡啶，以使婴儿溶血症的风险降到最低。 Recommendations regarding breastfeeding in situations in which the mother is undergoing either diagnostic procedures or pharmacologic therapy must balance the benefits to the infant and the mother against the potential risk of drug exposure to the infant. There are only a limited number of agents that are contraindicated, and an appropriate substitute usually can be found. The most comprehensive, up-to-date source of information regarding the safety of maternal medications when the mother is breastfeeding is LactMed, an Internet-accessed source published by the National Library of Medicine/National Institutes of Health. A forthcoming AAP policy statement on the transfer of drugs and other chemicals into human milk will provide additional recommendations, with particular focus on psychotropic drugs, herbal products, galactagogues, narcotics, and pain medications. In general, breastfeeding is not recommended when mothers are receiving medication from the following classes of drugs: amphetamines, chemotherapy agents, ergotamines, and statins. There are a wide variety of maternally administered psychotropic agents for which there are inadequate pharmacologic data with regard to human milk and/or nursing infant’s blood concentrations. In addition, data regarding the long-term neurobehavioral effects from exposure to these agents during the critical developmental period of early infancy are lacking. A recent comprehensive review noted that of the 96 psychotropic drugs available, pharmacologic and clinical information was only available for 62 (65%) of the drugs. In only 19 was there adequate information to allow for defining a safety protocol and thus qualifying to be compatible for use by lactating mothers. Among the agents considered to be least problematic were the tricyclic antidepressants amitriptyline and clomipramine and the selective serotonin-reuptake inhibitors paroxetine and sertraline. Detailed guidelines regarding the necessity for and duration of temporary cessation of breastfeeding after maternal exposure to diagnostic radioactive compounds are provided by the US Nuclear Regulatory Commission and in medical reviews.Special precaution should be followed in the situation of breastfeeding infants with glucose-6-phosphate-dehydrogenase deficiency. Fava beans, nitrofurantoin, primaquine, and phenazopyridine should be avoided by the mother to minimize the risk of hemolysis in the infant. 来源：http://pediatrics.aappublications.org/content/129/3/e827.full 翻译：http://www.weibo.com/2514526082/zvv2Aev2H