Nonsteroidal Antiinflammatory Drugs During Lactation

Abstract

In Response: We thank Paech et al. for their close attention to detail in reading our recent review article [1]. We cited a chapter by Dailland [2], which recommends against the use of indomethacin during breast feeding because of the risk of neonatal seizures and nephrotoxicity. This chapter refers only to the single case report discussed above as evidence for the risk of associated seizures [3]. Indeed, the manufacturer has questioned the causal link between indomethacin therapy and convulsions [4] while reminding us that the manufacturer's prescribing information states that indomethacin use is contraindicated during pregnancy and lactation (based on lack of available toxicity data). Renal failure has been reported after in utero exposure to indomethacin [5], and intestinal perforation has been reported in neonates receiving indomethacin for closure of a patent ductus arteriosus [6]. Neither complication has been associated with maternal indomethacin ingestion during breast feeding. We agree with the analysis presented-there is scant evidence that indomethacin use by breast-feeding mothers poses appreciable risk to the infant. However, newer nonsteroidal antiinflammatory drugs are generally better tolerated, with less upper gastrointestinal bleeding and fewer central nervous system effects (headaches, drowsiness, tinnitus, and dizziness) [7]. James P. Rathmell, MD Department of Anesthesiology; University of Vermont College of Medicine; Burlington, VT Christopher M. Viscomi, MD Michael A. Ashburn, MD, MPH Department of Anesthesiology; University of Utah Medical Center; Salt Lake City, UT