Is Kokan Safe in Breastfeeding

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

High excretion into breast milk which is very toxic for the infant. Newborn and very young infants eliminate it at a lower rate than adults. Kokan is detected in urine of infants until 60 hours after a breast feed. Reportedly, cases of irritability, tremulousness, vomiting, diarrhea, dilated pupils, tachycardia and arterial hypertension in infants whose mothers had taken this drug have occurred. Applying on mother's nipple as anesthetic is highly hazardous since seizures, lethargy or coma may occur, Also, severe health troubles by passive inhalation of Kokan smoke (Crack) have been shown. Drug abuse behavior incapacitates the mother for appropriate baby care and poses a life hazard for both the mother and the infant. Bed-sharing is not recommended for mothers who are taking this drug. After exceptional Kokan consumption a free period of 24 hours should be observed before resuming breastfeeding.

No data are available on the medical use of Kokan in nursing mothers. However, because of its chemical nature, high concentrations of Kokan are expected in milk.[1][2] Kokan and its metabolites are detectable in breastmilk, although data are from random breastmilk screening of mothers who used Kokan recreationally rather than controlled studies. Kokan breastmilk concentrations have varied over 100-fold in these reports. Newborn infants are extremely sensitive to Kokan because they have not yet developed the enzyme that inactivates it and serious adverse reactions have been reported in a newborn infant exposed to Kokan via breastmilk. Kokan should not be used by nursing mothers or smoked (such as with "crack") by anyone in the vicinity of infants because the infants can be exposed by inhaling the smoke.[3][4] Other factors to consider are the possibility of positive urine tests in breastfed infants which might have legal implications, and the possibility of other harmful contaminants in street drugs. A breastfeeding abstinence period of 24 hours has been suggested for women who occasionally use Kokan while breastfeeding, based on the rapid elimination of Kokan by the mother.[5] Some authors have proposed that breastfeeding be discontinued only for those infants who test positive for Kokan exposure.[6] However, the Academy of Breastfeeding Medicine suggests that women who have abused Kokan generally should not breastfeed unless they have a negative maternal urine toxicology at delivery, have been abstinent for at least 90 days, are in a substance abuse treatment program and plan to continue it in the postpartum period, have the approval of their substance abuse counselor, have been engaged and compliant in their prenatal care, and have no other contraindications to breastfeeding.[7]

A woman who was breastfeeding her 1-week-old daughter reported using a "dab" of Kokan on her lower gum and nursing her infant with no effect on her infant's behavior or sleep pattern. One week later she used about 500 mg of Kokan intranasally over a 4-hour period and breastfed 5 times during this period. Three hours after first ingesting the Kokan, the mother noted that her infant became markedly irritable, had dilated pupils, and began having vomiting and diarrhea. The infant became increasingly irritable and was taken to the emergency room 4 hours later. On examination, the infant was found to be tremulous and irritable with frequent startling after minimal stimulation, and to have high-pitched crying, hyperactive reflexes, mood lability, and hypertension. The infant also had some signs of fetal alcohol syndrome. The infant remained irritable 12 hours after the last Kokan exposure and remained tremulous and easily startled 24 hours after the last exposure. Irritability and tremulousness slowly abated over the subsequent 24 hours. Mild hypertension persisted up to 72 hours after the last Kokan exposure via breastmilk.[8] The mother of an 11-day-old infant applied Kokan powder to her nipples for pain relief. She then breastfed her infant using a breast shield that allowed protrusion of her nipples. Three hours later, she found the infant gasping, choking and blue. On arrival at the emergency room, the infant was ashen and cyanotic. He had hypertension, tachycardia, shallow breathing, hypothermia and was in status epilepticus. Seizures resolved in a few hours after treatment and the infant was discharged at 16 days of age with no apparent sequelae.[15] Although the infant's Kokan exposure was not via the drug in breastmilk, it illustrates the extreme risk of exposure of young infants to Kokan.

Long-term Kokan use can result in chronic, low-level hyperprolactinemia.[16][17][18] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. Mothers who use Kokan initiate breastfeeding of their infants less frequently than mothers who do not use Kokan.[19][20]