Augmentin (Amox-Clav), Benzonatate, Promethazine DM

[TXEX_09]

Good Morning,

I was recently prescribed the following for a cold that turned into an ear infection:

Amox-Clav 875mg 1 tablet per 12 hours
Benzonatate 200mg 1 capsule 3 times daily
Promethazine DM Syrup 6.25-15MG/5ML 5ml per 6 hours

Here is my current nursing/pumping schedule during the work week. On weekends I nurse on demand.

Nurse 0700
Pump 1000
Pump 1400
Nurse 1800
Nurse 2000

What would be the best time to take the meds to reduce the impact to my 8 month old via breast milk? My doctor recommended I pump and dump during this time, but I'd really rather not throw out the "liquid gold".

All of my drugs are kept up high and are in child-proof containers, so accidental ingestion of the medicines aren't my main concern.

I have been taking the Promethazine only before bed, not during the day due to the drowsiness associated with it. How long would it take to be out of my system? My baby sleeps through the night so I do not need to nurse then.

If the Benzo is high risk, could I just take DayQuil instead? (Acetaminophen 325mg, Dextromethorphan HBr 10mg, Phenylephrine HCl 5mg) Or are those two totally different things?

Thank you very much for all the support you give to worried (and usually exhausted!) mothers.

[Sandra]

TXEX_09,

Augmentin (amox-clav) is rated an L1-limited data-compatible. The amount transferred into breast milk is 0.9% of your dose. Take it right after you breastfeed and half the medication is out in less than 2 hours, monitor your infant for vomiting, diarrhea, rash and thrush.

Benzonatate (Tessalon Perles) are rated an L4-no data-possibly hazardous. [COLOR=#333333][FONT=lucida grande]With as little as 200 mg (typical dose 200 mg three times a day) serious toxicity can occur including agitation, seizure, coma, hypotension, cardiac arrhythmias, cardiac arrest and death. Avoid use in lactation.

Promethazine DM contains 6.25mg of promethazine, 15mg of dextromethorphan hydrobromide, and 7% alcohol.

Promethazine (Phenergan) is rated an L3-no data-probably compatible. [/FONT][/COLOR][COLOR=#333333][FONT=lucida grande]We have no data available on the transfer of promethazine into breast milk, although it has been used clinically in pediatrics with no untoward effects. There are numerous suggestions that this product may increase the risk of SIDS, so if your infant has a history of apnea use with extreme caution. This medications peak time is 4.5 hours, and has a half-life of 9-16 hours. Take this medication after your last feed at 2000 so that potentially half the medication is out. Monitor your infant for sedation or irritability, not waking to feed/poor feeding, dry mouth, weight gain, extrapyramidal symptoms, and apnea. ( A normal adult dose is 25mg so there is a smaller amount in the cough preparation.)

Dextromethorphan is rated an L1-no data-compatible. Dextromethorphan is a weak antitussive commonly used in children and adults and is the safest of the antitussives. No data on its transfer into human milk are available. It is very unlikely that enough would transfer via milk to provide clinically significant levels in a breastfed infant. Monitor for sedation.

Phenylephrine is rated an L3-no data-probably compatible. Phenylephrine is probably okay to use during breastfeeding due to its poor oral absorption. Although there are some concerns for decreased milk production similar to pseudoephedrine, especially in late-lactating mothers (breastfeeding longer than a year). A suitable decongestant in breastfeeding is oxymetazoline. Take right after breastfeeding, peak time is in the first our and half-life is 2-3 hours. Monitor your infant for agitation, poor sleep patterns, and tremors.

Tylenol (acetaminaphen) is rated an L1-extensive data-compatible. The amount transferred into milk is 8.8-24.2% of your dose. Peak time is in the first hour, and half-life is 2 hours. Do not exceed 3000mg in 24 hours. Monitor for gastric upset and diarrhea.[/FONT][/COLOR]


I hope this helps.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519