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Thread: L2 medications.

  1. #1
    Join Date
    Mar 2006
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    190

    Default L2 medications.

    I posted the other day that I suspected I had another DVT, and I do. They are wanting to start me on warfarin right away and I'm hearing conflicting info. The doctor treating me says it definitely goes through the breast milk and effects the baby's clotting factors, while her pediatrician says that it is a low risk drug and the tests say that in studies it shows no indication off effecting her, even though it does go through the breast milk.

    I'm really limited on my choice of drugs, and obviously I HAVE to take it, although I'm hoping to avoid the injection route as warfarin, fortunately, is a pill.

    So, do any of the LLL people have a reference where they could check the drug info for me. At this point the benefits out-weigh the risks, because I HAVE to take either/or (warfarin or heparin). I guess I'm more just wondering what the interactions ARE, as opposed to whether I should take it (because I have no choice).

  2. #2
    Join Date
    Jan 2006
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    1,198

    Default Re: L2 medications.

    I just did a quick hunt on Dr Hale's forums (while you are waiting for one-on-one info from someone who knows more directly!), and found this set of posts:

    http://66.230.33.248/discus/messages...tml?1146165174

    Maybe something in here might be helpful?

    Best of luck, Jsmom

  3. #3
    Join Date
    Apr 2006
    Posts
    1,813

    Default Re: L2 medications.

    I found this in The Nursing Mother's Companion, appendix C: The safety of drugs during BF:

    Some anticogulants (such as heparin, enoxaparin, and dalteparin) are injected; others (such as warfarin) are taken orally. Injected anticoagulants can be safely used during lactation because they do not pass well into milk nor get well absorbed by the nursing infant. Although warfarin was thought for many years to endanger the breastfeedin infant, newer evidence indicates that this oral drug is acceptable as well; only small amounts are found in breast milk.


    The ones that says to avoid are ticlopidine and clopidogrel, b/c they act in a different way and haven't been study on the nursing infant.

    HTH

  4. #4
    Join Date
    Mar 2006
    Posts
    190

    Default Re: L2 medications.

    I would either take heparin or warfarin, so I don't even recognize any of the others. I injected myself twice a day for my whole pregnancy, so I'm relieved that warfrin is ok. My bruises are just starting to clear up.

  5. #5
    Join Date
    Mar 2006
    Posts
    190

    Default Re: L2 medications.

    When my husband went to fill the prescription for my warfrin the pharmacist said NOT to BF while taking it, but to pump and dump. I can't do that for 3 months! There's no guarantee I could get her to go back to the breast after that long, and I'm not entirely convinced the risks of warfarin are worse then 3 months on formula.

    Anyone?

  6. #6
    Join Date
    Jan 2006
    Location
    Charleston SC
    Posts
    2,601

    Default Re: L2 medications.

    Nope, I would def continue to nurse. I had checked on this same issue for a friend in your same situation. Her med was Cumadin and it was a L2, that is the same category as like IB profin and zoloft. I will pray for you, what were your symptoms of another clot? That can be so scary.

  7. #7
    Join Date
    Jan 2006
    Posts
    1,551

    Default Re: L2 medications.

    Hi North_Of_60,
    You've been hearing some conflicting information about this drug and its safety while breastfeeding and you're trying really hard to make the best decision you can. LLL Leaders are not qualified to give approval for any particular drug, but we can give you access to published information that may help you as you discuss this with your HCP and your baby's HCP.

    The drug warfarin is listed on this table from the American Academy of Pediatrics. AMERICAN ACADEMY OF PEDIATRICS:
    The Transfer of Drugs and Other Chemicals Into Human Milk
    TABLE 6
    Maternal Medication Usually Compatible With Breastfeeding


    You already know that according to Hale's book, Medications and Mothers' Milk, 2004, warfarin is considered L2.
    L2 SAFER: Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

    You may want to call a local Leader and ask her to read the whole passage of Hale's description of warfarin. This is information you can discuss with your health care "team". Hale bases his findings on two studies, done in 1977 and 1983. I can get you specifics on those studies if you like.

    In part, Hale writes, "Warfarin is a potent anticoagulant. Warfarin is highly protein bound in the maternal circulation and therefore very little is secreted into human milk. Very small and insignificant amounts are secreted into milk but it depends to some degree on the dose administered."
    "According to these authors, maternal warfarin apparently poses little risk to a nursing infant and thus far has not produced bleeding anomalies in breastfed infants. Other anticoagulants, such as phenindone, should be avoided. Observe infant for bleeding such as excessive bruising or reddish petechia (spots)."
    There's another bit specific to breastfeeding premature infants.
    There is a long list of potential drug interactions, and many agents that may increase or decrease the anticoagulant effects.
    The adult dose is listed as 2-10 mg daily.

    Mary

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