Heartburn - Tagamet and Pepcid
I am nursing my 14 1/2 month old daughter once a day, in the morning and sometimes once in the evening. I know that when I was exclusively nursing I could not take Tagamet or Pepcid AC for heartburn. Now that I am only nursing once or twice a day, would taking either of those medications have any effect on my daughter?Question:
Heartburn is caused by the backup of stomach acid into your esophagus. Tagamet and Pepcid are both H2 blockers, also known as histamine receptor antagonists. They reduce the production of stomach acid, preventing or relieving symptoms of heartburn.
Tagamet (cimetidine) is secreted into human milk. Though it has a high milk:plasma ratio (of approximately 4.76 to 11.76, depending on maternal dose), the amount a baby receives through his mothers' milk is quite small - approximately 6 mg. per liter of milk. (A typical pediatric dosage for reflux is 8 to 20 mg. per day.) It is approved for use in nursing mothers by the American Academy of Pediatrics. The adult half-life of this drug is 2 hours and it peaks in your bloodstream in approximately .75 to 1.5 hours. (The half-life is the amount of time it takes for a drug to diminish by one-half. 50% is cleared in the first half-life, which in this case is 2 hours; 25% more is cleared in the next 2 hours; 12.5% in the next 2 hours, and so on.) Since you are only nursing once or twice a day, if you dose following a feed, very little, if any, of this medication should be present 12 or 24 hours later.
Pepcid (famotidine) has a lower milk:plasma ratio (.41 to 1.78) than other H2 blockers that "make it a preferred choice" (Hale 1997.) The adult half-life of this medication is 2.5 to 3.5 hours and it peaks at 1.3 to 5 hours after administration. Again, since you are nursing only once every 12 to 24 hours, very little of this medication should be present by the next nursing, if you dose immediately following a feed. This drug has not yet been reviewed by the American Academy of Pediatrics.
Reference: Medications and Mothers' Milk, Thomas Hale, R.Ph., Ph.D., 1997
You may be able to eliminate or reduce heartburn without the use of medication:
- Maintain a normal weight
- Avoid large meals - eat small meals more frequently
- Eat to appetite - don't overeat
- Follow a low-fat diet
- Consume your last meal/snack several hours before bedtime
- Avoid fatty foods, chocolate, caffeine, nicotine, and alcohol, or other foods that are a problem for you.
Short-term or occasional use of H2 blockers such as Tagamet and Pepcid is recommended. Do not use for an extended period of time without medical supervision. If you are experiencing heartburn on a regular basis it would be wise to schedule a visit with your Health Care Provider for a thorough evaluation. Best wishes for good health!Answer: