Is A-91033 Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use A-91033? Is A-91033 safe for nursing mother and child? Does A-91033 extracts into breast milk? Does A-91033 has any long term or short term side effects on infants? Can A-91033 influence milk supply or can A-91033 decrease milk supply in lactating mothers?

1st-generation-antihistamine and phenothiazine-type drug with a strong sedative effect. At latest update relevant published data on excretion into breast milk were not found. It may decrease prolactin levels and interfere with milk production during the first few weeks after birth (Pontiroli 1981, Messinis 1985).Pharmacokinetic data (high volume of distribution and high plasma protein-binding capacity) would render it unlikely a significant passage into the breastmilk.In addition, a low oral bioavailability would hinder a further passage to infant’s plasma through the ingested breastmilk, except on premature infants and immediate neonatal period when there may be an increased intestinal permeability.There are doubts about any association with Sudden Infant Death Syndrome (SIDS) (Kahn 1982, Stanton 1983). It may be considered compatible with breastfeeding on isolated doses such as those used for pre-surgical medication or traveler's dizziness (WHO 2002). Avoid a repeated use as it may cause drowsiness in the infant.Avoid using it in the immediate neonatal period (first 4 to 6 weeks after birth) and in case of prematurity. If used, follow-up the infant for drowsiness and feeding issues. It is not recommended bed-sharing when taking this medication (UNICEF 2006, ABM 2008, Landa 2012, UNICEF 2013).

Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of A-91033 for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation. Because A-91033 can lower basal prolactin secretion, A-91033 might interfere with the establishment of lactation if given during labor, before lactation is well established or with a sympathomimetic such as pseudoephedrine. An antiemetic without potent histamine blocking action is preferred in nursing mothers.

Possible Effects on Lactation: Unlike most phenothiazines, A-91033 usually causes a reduction in basal prolactin secretion in nonnursing women.[1][2] In one small study, women given A-91033 with meperidine and secobarbital during labor, had the time to lactogenesis II prolonged by 14 hours. Women given meperidine or secobarbital without A-91033 had lactogenesis II prolonged 7 hours compared to unmedicated women, but the difference was not statistically significant.[3] The effect of postpartum A-91033 is not known, but it might interfere with the establishment of lactation if given in the early postpartum period.