Kinetics of the translactal passage of digoxin from breast feeding mothers to their infants
- 30 Downloads
In order to find out whether digoxin therapy of nursing mothers might produce discomfort in suckling infants we have investigated the kinetics of the transfer of digoxin from plasma to milk in 11 nursing mothers. After intravenous or oral application of a single dose of 0.5 mg or 0.75 mg digoxin simultaneous serum, fore- and hindmilk samples were taken. Obviously, a rapid equilibrium occurred between the serum and the milk compartments and there was no difference between fore- and hindmilk. All three digoxin concentration profiles ran parallel with a milk to serum ratio of 0.6 to 0.7. The curves could best be fitted by the sum of two exponential functions. For predicting the digoxin intake into the suckling infant, simulations were carried out on the basis of two coupled compartment models.
When the kinetic milk data as well as the kinetic data obtained in infants were fitted by this model it could be shown that even in the case of long half-lives only about 3% of the therapeutic drug levels were reached in the baby. Thus, one can conclude that digoxin accumulation to toxic concentrations should not occur in infants of women treated with appropriate doses of digoxin.
Key wordsKinetics Translactal passage Digoxin Breastfed infants
Unable to display preview. Download preview PDF.
- 1.Anderson PO (1979) Drugs and breast feeding. Seminars in Perinatology 3:271–278Google Scholar
- 2.Chan V, Tse TF, Wong V (1978) Transfer of digoxin across the placenta and into breast milk. Br J Obstet Gynaecol 85:605–609Google Scholar
- 3.Doherty JE (1973) Digoxin: Present knowledge of pharmacokinetics and pharmacodynamics. Symposium on Digitalis. In: Storstein O (ed). Oslo Gyldendal Norsk Forlag, pp 419–428Google Scholar
- 4.Larbig D, Haasis R, Kochsiek K (1978) Die Glykosidkonzentration und ihre klinische Bedeutung. Forum cardiologicum. Mannheimer Morgen Großdruckerei und Verlag GmbH, MannheimGoogle Scholar
- 5.Loughnan PM (1978) Digoxin excretion in human breast milk. J Pediatr 92:1019–1020Google Scholar
- 6.Marcus FI (1973) Metabolism of digoxin in normal man and factors influencing the body distribution. Symposium on Digitalis. In: Storstein O (ed). Oslo Gyldendal Norsk Forlag, pp 112–125Google Scholar
- 7.Ochs HR, Greenblatt DJ, Bodem G (1980) Single- and multipledose kinetics of intravenous digoxin. Clin Pharm Ther 28:340–345Google Scholar
- 8.Ohnhaus EE, Spring P, Dettli L (1972) Protein binding of digoxin in human serum. Eur J Clin Pharmacol 5:34Google Scholar
- 9.Ohnhaus EE (1978) Bioavailability of digoxin in renal insufficiency and heart failure. Cardiac Glycosides “International Symposium”, Bonn, Germany, January 27–29, 1977. In: Bodem G, Dengler H-J (eds). Springer, Berlin Heidelberg New York, pp 181–189Google Scholar
- 10.Oliver GC, Taxman R, Frederikson R (1973) Influence of congestive heart failure on digoxin blood levels. Symposium on Digitalis. In: Storstein O (ed). Oslo Gyldendal Norsk Forlag, pp 336–347Google Scholar
- 11.Reinhardt D (1980) Arzneimittel während der Stillzeit. Sozialpädiatrie 2:469–473Google Scholar
- 12.Reinhardt D, Richter O (1981) Mechanismen des Arzneimittelübergangs in die Muttermilch. Monatsschr Kinderheilk 129:1–6Google Scholar
- 13.Richter O, Reinhardt D (1980) The transference of drugs from breast-feeding mothers to their infants: a pharmacokinetic model. Biol Res Preg 1:112–117Google Scholar
- 14.Wettrell G (1976) Digoxin therapy in infants. Acta Paediatr Scand [Suppl] 257:3–28Google Scholar
- 15.Wettrell G (1977) Distribution and elimination of digoxin in infants. Eur J Clin Pharmacol 11:329–335Google Scholar
- 16.Windorfer A, Gasteiger H (1978) Stillen und Medikamente. Klin Paediatr 190:219–225Google Scholar