急...請幫我看藥物影響(英文版)...感激不盡

一個多月嚴重失眠,有幾天還完全沒睡

打過電話給陳昭惠醫師詢用藥,下面是她提供的網站(lactmed)查詢結果

Lorazepam哺乳時能用嗎?

英文通媽媽幫我看一下,如果不行,我可能還要找其他藥或換醫生或斷母奶

感激不盡

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Drug Levels and Effects:

Summary of Use during Lactation:

Lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is administered directly to infants. Lorazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.

Drug Levels:

Maternal Levels. Four women were given 3.5 mg of lorazepam orally 2 hours before undergoing cesarean section. Colostrum levels of lorazepam averaged 8.5 mcg/L at 4 hours after the dose; conjugated lorazepam metabolites were not measured.[1]

Another woman taking 2.5 mg orally twice a day for the first 5 days postpartum had milk levels of free and conjugated lorazepam of 12 and 35 mcg/L, respectively, at an unspecified time on day 5.[2] Since infants can deconjugate and absorb glucuronides, the total drug level is probably more important than the free drug alone. Using the total amount excreted, an exclusively breastfed infant would receive about 7 mcg/kg daily with this maternal dosage or about 8.5% of the maternal weight-adjusted dosage.

A woman who was 4 weeks postpartum was taking lorazepam 2.5 mg 1 to 3 times daily and lormetazepam, which is partially metabolized to lorazepam, 2 mg once daily. On day 5 of therapy after taking 2 doses of lorazepam in the previous 8 hours, her lorazepam milk level was 123 mcg/L. On day 6 after having taken 3 doses in the previous 24 hours, her milk lorazepam level was 89 mcg/L. On day 7, milk levels were 55 and 40 mcg/L at 14 and 18.5 hours after her last dose, respectively.[3]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants:

In one case, the newborn infant of a mother taking 2.5 mg of lorazepam orally twice daily for 5 days after delivery showed no signs of sedation.[2]

Possible Effects on Lactation:

Relevant published information was not found as of the revision date.

AAP Category:

Effect on nursing infant is unknown but may be of concern.[4]

Alternate Drugs to Consider:

Midazolam, Oxazepam

References:

1. Summerfield RJ, Nielsen MS. Excretion of lorazepam into breast milk. Br J Anaesth. 1985;57:1042-3. Letter. PMID: 4041315

2. Whitelaw AGL, Cummings AJ, McFadyen IR. Effect of maternal lorazepam on the neonate. Br Med J (Clin Res Ed). 1981;282:1106-8. PMID: 6113019

3. Lemmer P, Schneider S, Muhe A, Wennig R. Quantification of lorazepam and lormetazepam in human breast milk using GC-MS in the negative chemical ionization mode. J Anal Toxicol 2007;31:224-6. PMID: 17555647

4. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352

Substance Identification:

Substance Name: Lorazepam

CAS Registry Number: 846-49-1

Drug Class:

Hypnotics and Sedatives

Anti-Anxiety Agents

Benzodiazepines

Administrative Information:

LactMed Record Number:

364

Last Revision Date:

20071227

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

頑子馬迷
冠旗的米迷 2008-03-05 18:21:58 #1F
 

推一下

微米
微米 2008-03-05 18:39:11 #2F
 

學名:Lorazepam 商品名:Ativan

成份:

藥理作用似乎主要限於腦部的邊緣系統(Limbicsy Stem),

據報告在推薦的劑量方式下,它選擇性的抑抗焦慮作用。

治療項目:

焦慮失眠症。由於本品的效力(Efficacy),及相對的安全性,

它可應用於廣泛的適應症。

1由情緒引起的自律神娙症狀,如頭痛、心悸、胃腸久適、失眠等。

2在許多器官性疾病,焦慮是使其惡化的因素,

 對於一些慢性焦慮會使之預後不良的病況,

 例如心臟血管疾病、胃腸失常。

3精神官能症包括焦慮、抑鬱、強迫思想及行為、

 恐懼及混合反應。

4精神病或嚴重抑鬱症之焦慮,作為輔助治療。

5另外,本品是一種外科手術前用藥,可在手術前夜或手術前,

 至於手術前何時服用,則由醫師決定。

用法用量:

每日平均劑量1.5mg~3mg分之使用,

精神科使用視焦慮程度每日劑量通常由3mg~10mg分次服用。

注意事項:

1白天倦睡,通常2~3天年會消失,但必要時依照個別需要,

 調整劑量,可以減少此現象。

2患者曾使用抗焦慮劑,可以較高劑量開始。

3如果失眠是主要的症狀,睡前的劑量可以增加。

4手術前給藥,於手術前夜或手前可給予2~4mg,

 服藥與手術間之時間由醫師決定。

5年病人通常使用建議的半量即可,視反應再逐漸增力。

6小孩(6~12歲)亦是適合較低劑量。

76歲以下小孩之使用劑量尚未建立。

8本品與Neuroleptices藥物合併使用時,後者可以減量。

懷孕及授乳注意事項:

妊娠期的使用,有些曾報告提:

妊娠最初三個月期間使用Minor Tranquilizers

(Chlordiazepoxide, Diazepam, and Meprobamate)

與先天性畸型危險性的增加有關聯。

本品為Benzodiazepine衍生物之一,也還沒有足夠研來決定

它是否與胎兒異常危險性的增加有關。因為使用這類藥物很

少是緊急的事情,所以在這一段時間應該避免使用。

生育年齡的婦月在接受此類藥物治療期間,也應該考慮到懷

孕之可能性,同應勸告女在治療期間,一旦懷孕或準備懷孕

,應與醫師詩論有關希望停藥的問題。

使用禁忌:

1.對BENZODIAZEPINES或其賦形劑過敏者

2.急性挾角性青光眼

3.嚴重呼吸衰竭

4.禁用於動脈內投予

預防事項:

如同使用其他Benzodiazepine一樣,應該注意以下的預防事項:

1如同多數中樞神經系統作用藥物一樣,患者應盡量避免駕毌

 及操作危險性機械。

2提醒患者,服用本品後,對酒精之耐量或化種中樞神經系抑

 制劑之耐量將降低。

3與他種中樞神經作用藥物並用時,二者間之藥理作用應予考慮。

4如欲中止治療時,本品之劑量亦應逐漸減低。

服用過量處理:

除洗胃外,一般應實施支持性處理,應給予IV液,並保持空氣流通

bihuai
bihuai 2008-03-05 18:53:29 #3F
 

Lorazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.

lorazepam在泌乳中的濃度極低

半衰期短(所以代謝很快)

此藥不會對哺乳中的嬰兒造成副作用,

所以不要太擔心囉!

重點是只要有去看醫生一定要告知有在哺乳

醫生一定會幫妳查看開的藥可不可以吃的

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