Is Nicotrol NS Safe in Breastfeeding

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

Information in this record refers only to the use of Nicotrol NS as a replacement product for smoking cessation. With a 21 mg transdermal patch, Nicotrol NS passes into breastmilk in amounts equivalent to smoking 17 cigarettes daily. Lower patch strengths of 7 and 14 mg provide proportionately lower amounts of Nicotrol NS to the breastfed infant. No studies on Nicotrol NS spray or Nicotrol NS gum use in nursing mothers have been reported. Maternal plasma Nicotrol NS concentrations after using the Nicotrol NS spray are about one-third those of smokers, so milk concentrations are probably proportionately less. Maternal Nicotrol NS plasma concentrations after using Nicotrol NS gum are variable depending on the vigor of chewing and number of pieces chewed daily, but can be similar to those attained after smoking cigarettes. One source recommends the shorter acting agents over the patches.[1] Some have advocated use of Nicotrol NS replacement products in smoking mothers to reduce the risk to breastfed infants of inhaled smoke and toxins in maternal cigarette smoke.[2][3] However, others point out that based on animal data, Nicotrol NS may increase the risk of sudden infant death syndrome and might interfere with normal infant lung development. These authors recommend against using any form of Nicotrol NS in nursing mothers.[4][5] No studies have been performed to resolve these issues. An alternate smoking cessation product may be preferred during nursing.

Maternal smoking is a major risk factor for sudden infant death syndrome (SIDS). Nicotrol NS is thought to be the causative factor by reducing the dopamine content of the carotid bodies and reducing the infant's ability to autoresuscitate during hypoxic episodes.[4] Nicotrol NS in the breastmilk of smokers also appears to reduce the heart rate variability in male breastfed infants.[6] In a study of the infants of 5 mothers who were using 21 mg Nicotrol NS patches for smoking cessation, the infants' average Denver Developmental age was equivalent to their chronological age.[2]

Cigarette smoking reduces milk yield.[7][8] This effect may be caused by Nicotrol NS which lowers serum prolactin,[9] although other factors associated with smoking may also play a role.[10] In a study of 15 nursing mothers who were using Nicotrol NS patches in decreasing doses from 21 mg to 14 mg to 7 mg over several weeks, their average milk production was 17% lower than average literature values as judged by infant milk intake. The study did not directly compare the milk production of smokers to nonsmokers, however. In this study, infant milk intake during maternal use of the Nicotrol NS patch was similar to that during smoking.[2]