Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid while Breastfeeding

What is Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid ?

Is using Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid safe or dangerous while breastfeeding?

Codeine phosphate while Breastfeeding

CAS Number: 76-57-3

Compound of cough and pain medication. The cytochrome P450-CYP2D6 enzyme catalyzes morphine. It is excreted in breast milk in small amounts, much lower than the dose used for newborns and infants. The plasma levels of infants whose mothers take them are very low, less than usual therapeutic levels and assuming an insignificant relative dose, less than 1.5% (Meny 1993, Naumburg 1988, Findlay 1981), so it was considered safe for use during breastfeeding (Bar-Oz 2003, WHO 2002, AAP 2001, Moretti 2000, Spigset 2000, Mitchell 1999, Meny 1993). However, excessive sedation in the mother or infant may occur if they are rapid metabolizers of codeine to morphine due to an excess of the gene linked to the P450-2D6 enzyme: this occurs in <1% of Chinese, Japanese and Hispanic people; 3% African Americans; 1-10% of Caucasians and 16-29% of North Africans, Ethiopians and Saudis (Halder 2015, Sachs 2013). The genetic diagnosis of this characteristic is not available in usual clinical practice (Madadi, 2011). Codeine through breast milk has been linked to the appearance of neonatal apnea (Naumburg, 1988), drowsiness (Ito, 1993), neurological depression (Madadi, 2008) and, above all, a fatal outcome: a newborn whose mother had this genetic abnormality died at 13 days; the mother was taking 60 mg of codeine twice daily, morphine levels were normal in breast milk, but very high in the child's plasma (Madadi 2007, Koren 2006). Subsequently, the causality of codeine in this case has been called into question (Bateman 2008, Ferner RE 2008, Young 2007). A link has been found between the use of codeine during pregnancy and breastfeeding and the risk of developing neuroblastoma in the infant (Cook, 2004). Because of all this, and with newborns having a limited capacity for opioid elimination (Willmann, 2009) and the existence of more effective alternatives, many authors and institutions advocate completely discouraging its use in infants and breastfeeding mothers (FDA 2017, Al-Adhami 2016, Lazaryan 2015, AEMPS 2015, Sachs 2013, EMA 2013). Other authors advocate cautious use (some even in the case of rapid metabolizers), using the lowest possible effective dose and for no more than 4 days and monitoring for signs of sedation in mother and infant (Royal Berkshire-NHS 2016, Halder 2015, Reece-Stremtan-ABM Protocol#21 2015, Chow 2015, Kelly 2013, UKMi NHS 2013, Rowe 2013, Montgomery-ABM protocol#15 2012, Amir 2011, Madadi 2009, Madadi 2007, FDA 2007). The use of non-steroidal anti-inflammatory drugs (NSAIDs) better controls pain and with fewer side effects than codeine alone or in combination with paracetamol (Palanisamy 2014, Hendrickson 2012, van den Anker 2012, Madadi 2009, Nauta 2009, Willmann 2009), and codeine is not included either in international consensus on the treatment of migraines (Bordini 2016, Worthington 2013). Follow WHO standards for childbirth attendance, reduce cesarean sections and episiotomies, and therefore the need for analgesics in the first few days.

Pseudoephedrine hydrochloride while Breastfeeding

CAS Number: 90-82-4

Marketed on multiple compounds as a constituent of antitussives, mucolytics, expectorants and nasal decongestants (Nice 2000).Simple formulations (one active ingredient per drug) are preferable even more while breastfeeding. It is excreted into breast milk in a clinically non-significant amount (Findlay 1984, Kanfer 1993, Nice 2000, Aljazaf 2003) without major problems having been reported in infants whose mothers had received this medication (Ito 1993, Aljazaf 2003, Soasan 2014). Two infants out of ten appeared with mild irritability that did not require medical care (Ito 1993) with only 4 cases related to maternal pseudoephedrine intake having been declared to the French Pharmaceutical Surveillance Database in 26 years (Soasan 2014) . According to one author, it may decrease the milk production, hence a high intake of fluids is recommended to the mother (Nice 2000). Pseudoephedrine produced a variable and non-significant decrease on prolactin levels along with a variable decrease (between 3% and 59%, on average 25%, and a median 15%) on milk production in 8 women whose infants were beyond neonatal period (Aljazaf 2003).Based on the latter single work (Aljazaf 2003), it has been speculated with the use of pseudoephedrine to treat hypergalactia, galactorrhea and to inhibit milk production (Eglash 2014, Trimeloni 2016). Nor-pseudoephedrine was found in the urine of infants whose mothers had consumed a stimulant plant called Catha edulis o cat (Kristiansson 1987). Although not recommended during lactation by some authors (Rubin 1986, Amir 2011), others think it is compatible (Findlay 1984, Ghaeli 1993, Ito 1993, Mitchell 1999, Nice 2000). The American Academy of Pediatrics considers it to be a medication usually compatible with breastfeeding (AAP 2001). It is suggested the use of a lowest effective dose as possible avoiding a long-term use. Monitor milk production, especially if associated with use of Triprolidine (see specific info) during the neonatal period.

Chlorcyclizine hydrochloride while Breastfeeding

CAS Number: 82-93-9

It is a first generation anti-histaminic and piperazine drug with a moderate sedative effect. Commercialized in association with other drugs for coughing relief and expectorant compounds. Overall, avoid drug associations especially while breastfeeding.

Codeine phosphate while Breastfeeding

CAS Number: 76-57-3

Maternal use of codeine during breastfeeding can cause infant drowsiness, central nervous system depression and even death, with pharmacogenetics possibly playing a role.[1][2] Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral codeine to 2-4 days at a low dosage with close infant monitoring, especially in the outpatient setting.[2][3][4][5] If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.[6] Excessive sedation in the mother often correlates with excess sedation in the breastfed infant. Following these precautions can lower the risk of neonatal sedation.[7] Numerous professional organizations and regulatory agencies recommend that other agents are preferred over codeine or to avoid codeine completely during breastfeeding;[8][9][10][11][12] however, other opioid alternatives have been studied less and may not be safer.[13]

Pseudoephedrine hydrochloride while Breastfeeding

CAS Number: 90-82-4

Although the small amounts of pseudoephedrine in breastmilk are unlikely to harm the nursing infant, it may cause irritability occasionally. A single dose of pseudoephedrine decreases milk production acutely and repeated use seems to interfere with lactation. Mothers with newborns whose lactation is not yet well established or in mothers who are having difficulties producing sufficient milk should not receive pseudoephedrine. A treatment scheme has been reported for mothers with hypergalactia that uses pseudoephedrine to decrease milk supply.[1]

I already used Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid and meanwhile I breastfed my baby should I be concerned?

My doctor has prescribed me Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid, what should I do?

If I am using Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid, will my baby need extra monitoring?

Who can I talk to if I have questions about usage of Notuss-nxd | Codeine Phosphate, Pseudoephedrine Hcl, Chlorcyclizine Hcl Liquid in breastfeeding?