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I have a patient who is taking 5 mg of Valium once a day and inserting it into her vagina to relieve levator spasms. Her daughter is 4 months old and is gaining weight well on only breast milk. I know Valium is rated C for occasional use and D for chronic use, but that is when you take it orally. What about absorption into the bloodstream from a vaginal suppository? If she is taking it everyday, would you still rate it a class D?
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Kimberly:
This is a rather unique form of treatment and we have almost no data on the absorption kinetics of Valium(diazepam) from the vagina. I did manage to find one paper on the absorption of diazepam from the cervix/vagina. In this study they found plasma levels of diazpam of 27.2 ng/mL at 30 minutes following administration of 5 mg in a gel. Following an oral dose of 10 mg, plasma levels are about 600 ng/mL. So we could estimate, that plasma levels in a breastfeeding woman would possibly be about 1/10 that of oral administration (this is a poor estimate).
If this is true, then the amount of exposure for the infant is probably subclinical. The mom would simply have to observe the infant closely for sedation. As for giving it a rating, I really can't do that with such poor information. I can say it is probably OK for this mother to try breastfeeding while watching the infant closely.
Tom Hale Ph.D. -
Update on this thread?
Dr. Hale et al:
Any updates on the use of valium suppositories during lactation? I see this thread was from 2010.
Thank you,
RebeccaComment
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Rebecca126, thanks for posting,
The information is the same as the post below from Dr Hale posted 4-19-2011
This is a rather unique form of treatment and we have almost no data on the absorption kinetics of Valium(diazepam) from the vagina. I did manage to find one paper on the absorption of diazepam from the cervix/vagina. In this study they found plasma levels of diazpam of 27.2 ng/mL at 30 minutes following administration of 5 mg in a gel. Following an oral dose of 10 mg, plasma levels are about 600 ng/mL. So we could estimate, that plasma levels in a breastfeeding woman would possibly be about 1/10 that of oral administration (this is a poor estimate).
If this is true, then the amount of exposure for the infant is probably subclinical. The mom would simply have to observe the infant closely for sedation. As for giving it a rating, I really can't do that with such poor information. I can say it is probably OK for this mother to try breastfeeding while watching the infant closely.
Tom Hale Ph.D.
If you have any other questions please contact the InfantRisk Center at 806-352-2519. Thanks,
Sandra Lovato R.N.
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