Diclegis & Nursing Toddler

[Claudia83]

Hello Ladies,

I have been suffering with Nausea and Vomiting since week 5. I was given Zofran at almost 7 weeks in and it hasn't really done much for me. I was in the ER Monday this week because I was dehydrated. Diagnosed with HG (didn't have this with first pregnancy), 3 bags of IV fluids later and I was feeling like a new woman. At my follow up, my doctor gave me Diclegis to try, but reading up on it says it's not advised to use for nursing an infant, but I am not nursing an infant (mostly because it causes drowsiness/feeling sedated), I am nursing a 2 year old toddler. He's also only nursing at bedtime and a few times throughout the night. I was wondering if any of you ladies here have had any experience with this drug while nursing an older child.

xposted in Gestational Complications.

TIA

 

[Claudia83]

Bump. Anyone?

 

[misspriss]

Diclegis is doxylamine succinate (unisom, antihistamine used for sleep) and pyridoxine hydrochloride (vit B6).

It is most likely not recommended for nursing infants because it can make them drowsy. It's not advised to make small infants drowsy (most medications not recommended for nursing is because it sedates them). I would assume nursing a 2 yr old before bed, a little drowsiness would not be bad.

Doxylamine:

Summary of Use during Lactation:
Small occasional doses of doxylamine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established.


Drug Levels:
Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
There are no reports of infants breastfed during maternal therapy with doxylamine. In one telephone follow-up study, mothers reported irritability and colicky symptoms 10% of infants exposed to various antihistamines and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.[1]


Possible Effects on Lactation:
Antihistamines in relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women.[2][3] However, suckling-induced prolactin secretion is not affected by antihistamine pretreatment of postpartum mothers.[2] Whether lower oral doses of antihistamines have the same effect on serum prolactin or whether the effects on prolactin have any consequences on breastfeeding success have not been studied. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

I could not find any information on pyridoxine hydrochloride (B6).

From the Diclegis prescribing information:

The molecular weight of doxylamine succinate is low enough that passage into breast milk can be expected. Excitement, irritability and sedation have been reported in nursing infants resumably exposed to doxylamine succinate through breast milk. Infants with apnea or other respiratory syndromes may be particularly vulnerable to the sedative effects of DICLEGIS resulting in worsening of their apnea or respiratory conditions.
Fatalities have been reported from doxylamine overdose in children. The overdose cases have been
characterized by coma, grand mal seizures and cardiorespiratory arrest. Children appear to be at a high risk for cardiorespiratory arrest. A toxic dose for children of more than 1.8 mg/kg has been reported. A 3 year old child died 18 hours after ingesting 1,000 mg doxylamine succinate. However, there is no correlation between the amount of doxylamine ingested, the doxylamine plasma level and clinical symptomatology.

From the VICKS website, about their product containing doxylamine:

While safe when taken correctly by adults, there are a few groups who should not take doxylamine. Elderly people should consult a physician before taking doxylamine, as older adults are prone to experience nervousness, restlessness, and agitation after ingesting this medication. Children younger than age 12 also are susceptible to these reactions, and should not take doxylamine unless under instruction by a doctor. Pregnant or breast-feeding women should talk to their doctor before using doxylamine

Essentially your toddler would be getting a dose of doxylamine. It could cause restlessness, agitation, or sedation. It is up to your and your doctor to discuss the risks and benefits of you taking the medication. However, you would only be taking 20mg slow release doxylamine.

In Nyquil there is 25mg doxylamine every 4 hours comparatively, to 20mg released over 24 hours.