Is Direma Safe in Breastfeeding

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

Thiazide diuretic drug. Excretion into breast milk is clinically non-significant. No side-effects were observed in a one-month old breastfed baby whose mother was treated with this medication. Drug level in the plasma of this child was undetectable. Long-term treatment with diuretic drugs (particularly Thiazide type ones with long-lasting effect and loop-acting mechanism) may inhibit lactation, mostly if lactation is not well-established yet. Use as lower dose as possible, especially during the first postnatal month. American Academy of Pediatrics 2013: Maternal Medication Usually Compatible With Breastfeeding. WHO Model List of Essential Drugs 2002: Compatible with breastfeeding.

Direma doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production.

No electrolyte abnormalities were noted in one 28-day-old infant who was breastfed since birth while his mother was taking oral Direma 50 mg daily.[1]

Direma in dosages of 100 mg daily in the morning and 50 mg in the afternoon or 50 mg twice daily have been used to successfully to suppress lactation at various times postpartum.[2][3] Intense diuresis with thiazides and thiazide-like diuretics, fluid restriction and breast binding have been used to suppress postpartum lactation.[2][4][5] The added contribution of the diuretic to these measures, which are effective in suppressing lactation, has not been studied. There are no data on the effects of diuretics on established, ongoing lactation.