Because of the low levels of digoxin in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. If the mother is to receive digoxin intravenously, avoidance of breastfeeding for 2 hours after the dose will lessen the dose the infant receives.
In 11 women taking digoxin0.25 mg daily orally, milk digoxin levels obtained on days 3 to 7 postpartum were relatively constant at0.644 mcg/L. The amounts in milk represent an infant dosage of 2.3% of the maternal weight-adjusted dosage or0.97 mcg/kg daily, which is about 10% of the neonatal dosage.
Milk digoxin levels were0.41 and0.78 mcg/L in two mothers taking oral digoxin0.25 mg daily.
Milk digoxin levels ranged from undetectable (<0.5 mcg/L) to 1 mcg/L in 5 women treated with unspecified doses of digoxin. Milk and serum levels were similar.
A milk digoxin level of 1.9 mcg/L was measured in a mother taking0.75 mg daily of digoxin during pregnancy and postpartum.
After an intravenous bolus dose of digoxin0.5 mg in 11 women, digoxin serum and milk levels rapidly equilibrated, with high levels occurring rapidly, dropping to low levels by about 2 hours after the dose. A pharmacokinetic simulation using data from these mothers indicate that a fully breastfed infant would obtain a serum level of only about 3% of a therapeutic level with maternal intake of0.5 mg daily of digoxin.
In two breastfed infants whose mothers were taking oral digoxin0.25 mg daily, digoxin was undetectable (<0.1 mcg/L) in their serum after 10 days of maternal therapy.
A mother took0.75 mg daily of digoxin during pregnancy and postpartum. Her infant had a serum level of0.2 mcg/L after nursing for 7 days, having decreased from a level of0.6 mcg/L at birth.
Effects in Breastfed Infants:
At least 4 infants have been reported to have been breastfed in studies on digoxin in breastmilk. None had any detectable digoxin effect.
Possible Effects on Lactation:
Relevant published information was not found as of the revision date.
1. Chan V, Tse TF, and Wong V. Transfer of digoxin across the placenta and into breast milk. Br J Obstet Gynaecol. 78;85:605-9. PMID:687540 2. Loughnan PM. Digoxin excretion in human breast milk. J Pediatr. 78;92:1019-20. PMID:660341 3. Levy M, Granit L, Laufer N. Excretion of drugs in human milk. N Engl J Med. 1977;297:789. Letter. PMID:895815 4. Finley JP, Waxman MB, Wong PY et al. Digoxin excretion in human milk. J Pediatr. 1979;94:339-40. Letter. PMID:762640 5. Reinhardt D, Richter O, Genz T et al. Kinetics of the transplacental passage of digoxin from breast feeding mothers to their infants. Eur J Pediatr. 1982;138:49-52. PMID:7075628 6. Miller MR, Withers R, Bhamra R et al. Verapamil and breast-feeding. Eur J Clin Pharmacol. 1986;30:125-6. PMID:3709626
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