need recommendations for anti-cholinergic or beta blockers

[ameliasmomma]

I have had severe abdominal pain, bloating, nausea and vomiting as well as diarrhea for nearly 3 months. I am currently breastfeeding my 9 month old. The first med my dr suggested was the only one I have found as definitely contraindicated for breastfeeding (dicyclomine). He wants to use an anticholinergic or beta blocker to help relieve some of my symptoms.

Thanks in advance!

[cpride]

Dear ameliasmomma,

For diarrhea, loperamide is a good choice for breastfeeding as only 0.03 % of your dose transfers into breastmilk. At this low amount, no untoward effects would be expected in a breastfeeding infant. Propranolol and metoprolol are two beta blockers that are compatible with breastfeeding with less than 2 % of your dose transferring into breastmilk. Observe your infant for lethargy and poor feeding. Anticholinergic medications should be used with caution in breastfeeding due to the risk of urinary hesitancy, constipation, and dilated pupils. Hyoscyamine has a short half-life (time it takes for half of the drug to be eliminated) of 3.5 hours and is probably safe when used in low doses, but observe for the above symptoms in your infant. Waiting past the first half-life would reduce risk. If your infant sleeps 6 to 7 hours at night, taking your dose at bedtime would reduce the risk even more as 75 % of the dose would be eliminated by then. Hope this information helps. If you have further questions, once you and your physican decide on your treatment plan, call us at the InfantRisk Center at 806-352-2519. We are open 8 to 5 CDT, Monday through Friday.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center