Esomeprazole and breastmilk going to prem babies

[Jenny W]

Good Day,

Esomeprazole is listed as an L2 In Medications and Mothers Milk and it is noted that it is unlikely to be absorbed by the infant while dissolved in milk due to instability in acid. Would this apply to very premature babies as well?

Would this medication be considered safe for donor mothers to take when donating to a milk bank?

Some milk banks allow donor mothers to take Omeprazole but do not specify Esomeprazole as also being compatible with donating breastmilk.

Regards
Jenny

[nicholec]

Hi Jenny,

Milk banks that are accredited through HMBANA have a medications standards committee with international experts in lactation pharmacology (including some of ours!) to make sure that safety is maintained for even the most vulnerable babies. Each milk bank has the differing capacities to update their list as the standards committee meets.

There are many differing expert opinions on the transition of pH for neonates, much less for premature infants. With an overestimated relative infant dose of 2%, it is unlikely that there would be any issues with mothers who take esomeprazole at normal dosages donating their milk for use by preemie or full term infants.

Really, there isn't going to be much difference in omeprazole and esomeprazole. Fun organic chemistry lesson (thank you, Dr. Krutsch): molecules come in left- and right-handed versions. It's usually a 50/50 mix; sometimes one form is more active than the other. Sometimes, the pharmaceutical developer can make the purified version of the molecule when the drug is about to go generic. Omeprazole is a mixture of the right (also known as R or D enantiomers) and left (also known as S or L enantiomers) handed forms. Esomeprazole is the purified form of the left-handed S-omeprazole...es-omeprazole. Other fun examples: cetirizine and levocetirizine, albuterol and levoalbuterol, citalopram and escitalopram.

Nichole Campbell, MSN, APRN, NP-C
InfantRisk Center

[Jenny W]

Thank you, Nichole, that is very helpful.

We are a milk bank in South Africa, so unfortunately do not have access to the medicines standards committee that the HMBANA milk banks do. We therefore appreciate guidance form experts in the field such as yourselves.

Regards
Jenny