Midwifery Today Community

I need to know which might be a better choice for a breastfeeding mother:

Heparin

Lovenox

I may have to go on one or the other for a while to prevent the clotting in my varicosities from progressing and I wanted to know if one is excreted more or less in mommy's milk than the other. 

Thanks,

Heparin: "Due to its high molecular weight (40,000 Daltons), it is unlikely any would transfer into breastmilk.  Any that did enter the milk would be rapidly destroyed in the gastric contents of the infant." He gives it a L1 classification.  He doesn't list an alternative.

Lovenox:  He gives this an L3.  "... a low molecular weight fraction of heparin".  He gives a study of 12 women who got 20-40 mg of Enoxaparin (generic) every day for up to 5 days postpartum for "venous pathology (n=4) or caesarian section (n-8) and that there was "no change in anti-Xa activity ... noted in the breastfed infants.  Because it is a peptide fragment of heparin, its molecular weght is large (2000-8000 daltons).  The size alone would largely preclude its entry into human milk at levels clinically relevant.  Due to minimal oral bioavailablity, any present in milk would not be orally absorbed by the infant.  A similar compound, dalteparin, has been studied and milk levels are extremely low as well."  He lists Dalteparin as the alternative.

HTH.

Hi Brln,

Thanks so much.  That does help a LOT.  Could you just fill me in on the L1, L3 thing?  Does L1 mean its has the least amoun of risk?  What's the highest risk category?

Thanks again,

Robs

 L1 SAFEST: Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant.  Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

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.

L3 MODERATELY SAFE: There are no controlled studies in breastfeeding women, however, the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. (New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.)

L4 POSSIBLY HAZARDOUS: There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective.)

L5 CONTRAINDICATED: Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant.  The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Thanks.

Does he say what category the dalteparin (think its called Fragmin??) is in?  I'm going tonight.  We'll see if I've made enough progress to not go on the injections.

 Dalteparin Sodium (Fragmin, Low Molecular Weight Heparin) has an L2 classification.  Guess what he gives as an alternative?  Enoxaparin! (Lovenox)  Obviously it depends on which med you do the best on.