Is 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide? Is 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide safe for nursing mother and child? Does 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide extracts into breast milk? Does 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide has any long term or short term side effects on infants? Can 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide influence milk supply or can 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide 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 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide in breastmilk, amounts ingested by the infant are small and infant serum levels are very low. 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide is not be expected to cause any adverse effects in breastfed infants. Most mothers with myasthenia gravis are able to nurse successfully with 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide treatment, but occasionally breastfeeding must be discontinued to avoid excessive fatigue in the mother.

A woman was taking 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide 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 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide 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 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide 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 3-(Dimethylcarbamyloxy)-1-methylpyridinium bromide was not given. Nursing was sometimes disrupted to avoid exhaustion in the mother.[5]