Is Indomethacin compatible with breastfeeding? Do we have alternatives for Indomethacin?

Indomethacin

September 10, 2015 (Very Low Risk)

It is excreted into breast milk in non-significant clinically amounts.
There has not been side-effects described in children from treated mothers, except for a case reported in 1978 with convulsions in a newborn infant whose mother received a higher dose than recommended. However, a causal relationship was questioned by other author in the same publication.
Usually, breast milk and infant plasma levels have been found to be undetectable.

It has been successfully used with no side-effects on treated mothers who had high levels of Prostaglandin E (PGE) whose infants were suffering of “physiologic diarrhea)
This drug is used in neonates.
The American Academy of Pediatrics rates it as usually compatible with breastfeeding.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Indometacin
  • Indomethacin Sodium

Writings

  • Ινδομεθακίνη (Greek)
  • إيندوميتاسين (Arabic)
  • Индометацин (Cyrillic)
  • 吲哚美辛 (Chinese)
  • インドメタシン (Japanese)
  • C19 H16 ClNO4 (Molecular formula)

References

  1. Bordini CA, Roesler C, Carvalho Dde S, Macedo DD, Piovesan É, Melhado EM, Dach F, Kowacs F, Silva Júnior HM, Souza JA, Maciel JA Jr, Carvalho JJ, Speciali JG, Barea LM, Queiroz LP, Ciciarelli MC, Valença MM, Lima MM, Vincent MB. Recommendations for the treatment of migraine attacks - a Brazilian consensus. Arq Neuropsiquiatr. 2016Abstract Full text (link to original source) Full text (in our servers)
  2. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. Am Fam Physician. 2009Abstract Full text (link to original source) Full text (in our servers)
  3. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007Abstract
  4. Leonhardt A, Seyberth HW. Do we need another NSAID instead of indomethacin for treatment of ductus arteriosus in preterm infants? Acta Paediatr. 2003Abstract
  5. Bellander M, Ley D, Polberger S, Hellström-Westas L. Tolerance to early human milk feeding is not compromised by indomethacin in preterm infants with persistent ductus arteriosus. Acta Paediatr. 2003Abstract
  6. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  7. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000Abstract Full text (link to original source) Full text (in our servers)
  8. Li SY, Geng ZC, Wang AZ, Gao YL, Li M, Wang HD, Wang WY. The relationship between PGE2 level in mothers' milk and physiological diarrhea of the baby and the treatment. Chin Med J (Engl). 1994Abstract
  9. Beaulac-Baillargeon L, Allard G. Distribution of indomethacin in human milk and estimation of its milk to plasma ratio in vitro. Br J Clin Pharmacol. 1993Abstract Full text (link to original source) Full text (in our servers)
  10. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993Abstract Full text (link to original source) Full text (in our servers)
  11. Lebedevs TH, Wojnar-Horton RE, Yapp P, Roberts MJ, Dusci LJ, Hackett LP, Ilett KF. Excretion of indomethacin in breast milk. Br J Clin Pharmacol. 1991Abstract Full text (link to original source) Full text (in our servers)
  12. Helleberg L. Clinical Pharmacokinetics of indomethacin. Clin Pharmacokinet. 1981Abstract
  13. Eeg-Olofsson O, Malmros I, Elwin CE, Steen B. Convulsions in a breast-fed infant after maternal indomethacin. Lancet. 1978Abstract
  14. Fairhead FW. Convulsions in a breast-fed infant after maternal indomethacin. Lancet. 1978Abstract