DRUG NUTRIENT INTERACTION

SUBMITTED TO:
MA’AM FATIMA IFTIKHAR
SUBMITTED BY:
Arooba Irshad
M-16817
DNS-8
Question:

Summarize the drug nutrient interaction during lactation.

The process of selecting the appropriate pharmacological treatment for a lactating woman is a
complicated one. Any risk–benefit assessment must consider both the mother and the infant who
may potentially be exposed to drug but who is also experiencing the benefits of mother’s milk.
Almost all drugs will gain access to the milk. When we consider the physicochemical properties
of drugs, and the biological properties of breast milk and the mammary duct, it becomes apparent
that drugs gain access to the mammary compartment as to any other bodily fluid or tissue.

A drug’s lipid solubility, protein binding, acid/base characteristics, molecular weight, maternal
systemic bioavailability, and its half-life all influence transport into milk. Additionally, transport
proteins may play a role in active secretion of drugs into milk. An infant’s subsequent ‘‘dose’’
depends on the drug concentration in breast milk and the milk volume consumed. To further
quantify the amount of drug that the infant will be systemically exposed to, one must also
consider the gastrointestinal absorption or oral bioavailability as well as the metabolism,
elimination, and half-life of the drug in the infant.

Drugs that Increase Milk Production

Human milk production is highly regulated by prolactin and oxytocin. Both hormones are
involved in milk production and milk ejection, although the precise mechanism of milk
production are complex and do involve several hormones.

The regulation by these hormones can be disturbed by drugs particularly those which either
stimulate or suppress prolactin release. Dopamine, for example, acts on the pituitary to decrease
prolactin, thereby decreasing milk production.

Drugs which have an antidopaminergic effect such as domperidone and metoclopramide can
stimulate milk production (galactogogues) and are used clinically to do so. Neither has been
shown to cause serious adverse effects in infants.

Chlorpromazine, an antipsychotic, blocks the dopamine receptor, which would increase

prolactin and subsequently breast milk. It was shown to be clinically effective in doing so ;
however, its unfavorable side effect profile (e.g., extrapyramidal effects) would make it less
attractive as a galactogogue.

Human growth hormone was also shown to increase milk production though little is known
about its safety or mechanism of action and at this time, growth hormone is principally used to
increase milk production in cows.

One human trial investigated the use of thyrotropin-releasing hormone (TRH) for increasing
milk production as it will increase prolactin release. Though effective, use of TRH has been
limited, possibly due to its unknown effects on maternal thyroid function when used for this
indication.

Drug that May Decrease Milk Yield

As part of family planning, many women will need to consider their contraceptive choices during
lactation. Hormonal contraceptives are a mainstay in this regard; however, because they modify
the normal hormonal milieu of the woman, they are likely to have an impact on lactation and
milk production.

Current recommendations suggest that women should consider progestin-only agents

medroxyprogesterone or levonorgestrel implants as they do not impair milk volume.

In contrast, the estrogen–progestin combination contraceptives are not recommended since

they may decrease milk yield. The literature suggesting this is predominantly based on earlier
data with higher dose estrogen-containing products which are no longer available on the market.
A systematic review of the issue could not establish sufficient evidence that hormonal
contraceptives affected milk quality or quantity.

Nevertheless, most authorities recommend using the previously mentioned products as first-line
hormonal contraceptives in lactating women.

Studies have shown that alcohol disrupts the hormonal milieu in the lactating woman and may
impair milk ejection.

In addition, infants seem to respond to alcohol-induced flavor changes by consuming less milk.
Though occasional use of small amounts of alcohol in a lactating women is unlikely to pose
significant risk, based on these data, it would be prudent to avoid high-dose or chronic alcohol
consumption in lactating women.