Is Bromuro de piridostigmina [INN-Spanish] Safe in Breastfeeding

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

Reversible cholinesterase inhibitor used for treatment of Myasthenia Gravis (see specific info). It is excreted into breast milk at undetectable levels (Skoglund 1978) or clinically non-significant (Hardell 1982, Djelmis 2002) without harmful effects having been observed in infants whose mothers were treated (Skoglund 1978, Hardell 1982). Plasma levels in such infants were undetectable (Hardell 1982). Because of a low oral bioavailability it seems even more unlikely the pass to the infant’s plasma through ingested breastmilk, except in preterm infants and immediate neonatal period, when there may be an increased intestinal permeability. American Academy of Pediatrics: medication usually compatible with breastfeeding.WHO 2002 List of Essential Medicines: compatible with breastfeeding.

Because of the low levels of Bromuro de piridostigmina [INN-Spanish] in breastmilk, amounts ingested by the infant are small and infant serum levels are very low. Bromuro de piridostigmina [INN-Spanish] is not be expected to cause any adverse effects in breastfed infants. Most mothers with myasthenia gravis are able to nurse successfully with Bromuro de piridostigmina [INN-Spanish] treatment, but occasionally breastfeeding must be discontinued to avoid excessive fatigue in the mother.

A woman was taking Bromuro de piridostigmina [INN-Spanish] 120 mg every 4 to 5 hours for myasthenia gravis. Her breastfed (extent not stated) infant reportedly thrived and had no cholinergic side effects.[1] Two infants whose mothers were taking Bromuro de piridostigmina [INN-Spanish] 3 and 5 mg/kg daily during pregnancy and lactation were exclusively breastfed. Both infants gained weight and developed normally and had no signs of cholinergic side effects.[2]

Relevant published information in nursing mothers was not found as of the revision date. In animals, cholinergic drugs increase oxytocin release,[3] and have variable effects on serum prolactin.[4] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. In a case series of 69 pregnancies in 65 women with myasthenia gravis over 27 years, 49 patients received Bromuro de piridostigmina [INN-Spanish] during pregnancy and lactation. Lactation data were available for 33 patients, and 25 of them nursed successfully, although the number of these mothers who were taking Bromuro de piridostigmina [INN-Spanish] was not given. Nursing was sometimes disrupted to avoid exhaustion in the mother.[5]