Breast milk, barbiturates

Barbiturates are usually taken orally, sometimes with alcohol to increase the intoxicating effect, or by injection. The ultrashort-acting barbiturate Pentothal produces surgical anesthesia within about one minute after intravenous administration. The onset of action of the short- and intermediateacting barbiturates taken orally for insomnia is from 10 to 60 minutes, and the effects last up to six hours. Barbiturates distribute to body fat and are found in breast milk. They may cause drowsiness, slow heartbeat, and shortness of breath in babies of nursing mothers who are taking these drugs. 

Most sedatives and hypnotics achieve concentrations in breast milk sufficient to produce a pharmacologic effect in some infants. Barbiturates taken in hypnotic doses by the mother can produce lethargy, sedation, and poor suck reflexes in the infant. Chloral hydrate can produce sedation if the infant is fed at peak milk concentrations. Diazepam can have a sedative effect on the nursing infant, but, most importantly, its long half-life can result in significant drug accumulation. 

Barbiturates are also present in high concentrations in the breast milk of women who take them. Infants who consume this breast milk may experience side effects like excess sleepiness and lethargy. They may also experience withdrawal symptoms when weaned from breast milk. Long-term adverse effects of infant exposure to barbiturates in breast milk have not been well documented. However, the American Academy of Pediatrics cautions against breast-feeding while taking barbiturates because there may be risks to the infant. 

Most anticonvulsants are excreted in the breast milk in limited amounts, and their use is not generally a contraindication to breastfeeding. Barbiturates, ethosuximide, lamotrigine, and to a lesser extent carbamazepine and benzodiazepines can reach appreciable serum concentrations in breast-fed infants, who should be carefully observed. 

Many dmgs or their metabolites are excreted in mammary glands. These include narcotics such as morphine and codeine. Diuretics and barbiturates, which are weak acids, are less concentrated in breast milk. However, even small amounts of dmgs can accumulate causing an undesirable effect on an infant receiving breast milk. 

Butalbital is readily absorbed and distributed in most tissues in the body. This component can appear in breast milk and readily cross the placental barrier. Butalbital is excreted in urine as unchanged drug and as metabolites. The effect of butalbital alone has not been studied since butalbital is not available except in combination products. Barbiturates have anti-anxiety and muscle-relaxant properties. Barbiturates do not have analgesic action per se. Another potentially beneficial effect of butalbital is to antagonize the unwanted central stimulant effect of caffeine [8]. 

In addition to oral contraceptives, other drugs such as barbiturates (sleeping pills), laxatives, and salicylates (aspirin and similar substances) can be transmitted through breast milk. The taking of any drug during lactation should be done only under a doctor s supervision. 

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