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Clomid while nursing 16 month old

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  • Clomid while nursing 16 month old

    I am still nursing my son who is 16 months old about twice a day. I need to take clomid in order to ovulate (did the same with my son). I know it releases hormones and can dry up your milk. I was wondering though if there are any side effects from the hormones in clomid. I am not really concerned about my milk supply... My dr says its okay but I want another opinion because another dr said no. Should I pump and dump? Or if I take clomid in the early morning could I still nurse him before bed? Thank you so much!!

  • #2
    Dear Beccah,

    Clomiphene (Clomid) appears to stimulate the release of the pituitary gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), which result in development and maturation of the ovarian follicle, ovulation, and subsequent development and function of the corpus luteum. It has both estrogenic and anti-estrogenic effects. Clomiphene appears in some studies to be effective in suppressing lactation when used up to 4 days postpartum. In other studies done early postpartum, no changes in plasma prolactin levels (hormone needed for milk production) or milk production were noted. Further, its efficacy in reducing milk production in women, months after lactation is established, is unknown but believed to be minimal. Usually we caution breastfeeding mothers about the use of this product due to the risk of decreasing milk production. Since your child is older and not dependent on breastmilk for nutrition, the risk to your child is minimal. The time that Clomid is highest in your breastmilk would be at six hours after your dose so try to avoid that feeding time if possible. Let me know if you have further questions.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

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    • #3
      So are the hormones in clomid dangerous for him? Will they affect his development or anything? Or are there no studies on this? Thanks!!

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      • #4
        Dear Beccah,

        These hormones are naturally occurring in the body and this process would normally happen monthly as part of the menstrual cycle. For some reason, your system doesn't go through this process naturally, and you need Clomid to stimulate the process. The breast regulates the amount of hormones that enter milk and so there is minimal risk to your child.

        Sincerely,
        Cindy Pride, MSN, CPNP
        TTUHSC InfantRisk Center

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        • #5
          [QUOTE=cpride;1551]Dear Cindy

          I am researching clomiphene as my obgyn has recommend I take it to conceive my second baby. My first is currently 17 months and is still breastfeeding three times a day - I am reluctant to wean him this winter (i.e. before September 2013). I have not come across any references to the timing of the drug within breast milk other than in this post and I would like to do some follow-up reading. Can you please point me in the direction of any evidence on when Clomid is likely to be highest and when it is likely to leave my breastmilk? Thanks, Alison

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          • #6
            Dear Alison,

            Below is the information from the drug company package insert that discusses the pharmacokinetics of clomiphene (Clomid):

            Based on early studies with 14C-labeled clomiphene citrate, the drug was shown to be readily absorbed orally in humans and excreted principally in the feces. Cumulative urinary and fecal excretion of the 14C averaged about 50% of the oral dose and 37% of an intravenous dose after 5 days. Mean urinary excretion was approximately 8% with fecal excretion of about 42%.

            From Medications and Mothers' Milk, 2012 by Thomas Hale, PhD., the T max (the time the drug will be highest in your breastmilk) is 6 hours after your dose. The half-life (time it takes for half of the drug to be metabolized) is 5 to 7 days. With most medications, it takes 6 half-lives to be eliminated fully.

            We recommend waiting to breastfeed until after 6 hours to allow the highest amount to be metabolized. You may notice a decrease in your milk supply after taking clomiphene. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

            Sincerely,
            Cindy Pride, MSN, CPNP
            TTUHSC InfantRisk Center

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            • #7
              Hi there,

              I'm pretty sure I understand all the info in the above posts. I just had some clarifying questions.

              I'm just wondering how quickly Clomid is metabolized in my breastmilk after the T max (6 hours) is reached? Would the amount of Clomiphene in the milk be higher at 7 hours as opposed to 10 or 12 hours after taking it? Is it best to try to avoid feeding for as long as possible (without starving bub) after the Clomid so the amount in the milk is reduced as much as possible?

              It's recommended to wait to breastfeed after 6 hours from taking clomid as that allows the highest amount to be metabolized. Before 6 hours, I presume the levels are still high (& rising until 6 hours?) in my milk as it's not yet metabolized by my body?

              I hope this makes sense.

              Cheers, Lyndell

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              • #8
                Delly: T max means the time it takes to reach maximum plasma levels. So, it takes 6 hours to peak although its most active metabolite takes about 12 hours to peak.

                Then it takes about 72 hours for it to totally be undetectable in the maternal plasma compartment. Basically, there's no way to avoid the transfer of this drug short of stopping breastfeeding for at least 3 days.

                Tom Hale Ph.d.



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