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Klin Padiatr 2011; 223(07): 408-413
DOI: 10.1055/s-0031-1283193
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Stillen unter Methadon- bzw. Buprenorphin-Substitutionstherapie

Breast Feeding During Methadon- and Buprenorphin Therapy
M. J. Müller
1   Abteilung Pädiatrie III mit Schwerpunkt Pädiatrische Kardiologie und Intensivmedizin, Zentrum für Kinderheilkunde und Jugendmedizin der Universitätsmedizin Göttingen
,
M. Lange
1   Abteilung Pädiatrie III mit Schwerpunkt Pädiatrische Kardiologie und Intensivmedizin, Zentrum für Kinderheilkunde und Jugendmedizin der Universitätsmedizin Göttingen
,
T. Paul
1   Abteilung Pädiatrie III mit Schwerpunkt Pädiatrische Kardiologie und Intensivmedizin, Zentrum für Kinderheilkunde und Jugendmedizin der Universitätsmedizin Göttingen
,
S. Seeliger
1   Abteilung Pädiatrie III mit Schwerpunkt Pädiatrische Kardiologie und Intensivmedizin, Zentrum für Kinderheilkunde und Jugendmedizin der Universitätsmedizin Göttingen
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Further Information

Publication History

Publication Date:
26 September 2011 (online)

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Zusammenfassung

Hintergrund:

Die Zahl Opioidabhängiger, welche sich in Substitutionstherapie befinden, steigt kontinuierlich an. In Deutschland ist Methadon mit 57,7% das am häufigsten verordnete Substitutivum gefolgt von Buprenorphin mit 18,6%. Besonders schwangere Frauen und die ungeborenen Kinder profitieren von einer adäquaten Substitutionstherapie. Verunsicherung besteht jedoch für die Stillempfehlungen unter Substitutionstherapie, da sowohl Methadon als auch Buprenorphin in der Muttermilch angereichert werden und somit Sorge um Gesundheitsschäden des Neonaten nicht unbegründet sind. Stillvorteile müssen gegen mögliche neonatale Schädigungen abgewogen werden.

Methode:

Diese Übersicht basiert auf einer selektiven Literaturaufarbeitung unter Einbeziehung der PubMed-Datenbank und deutschsprachiger Konsensustexte. Verwendetete Suchbegriffe: (methadone*) AND (breastfeeding OR lactation), (methadone*) AND (human milk), (buprenorphine*) AND (breastfeeding OR lactation) und (buprenorphine*) AND (human milk).

Schlussfolgerung:

Nach Durchsicht der verfügbaren Literatur rechtfertigt die reine Substitutionstherapie mit Methadon oder Buprenorphin das primäre Abstillen nicht. Der Stillvorteil überwiegt die Risiken einer vital bedrohlichen neonatalen Substanzingestion, so dass Stillen unter beiden Substanzen möglich ist.

Abstract

Background:

The number of opiate addicted patients treated with opioid replacement therapy is continuously increasing. In Germany, 57.7% of these patients are treated with methadone and 18.6% with buprenorphine. This maintenance therapy provides several advantages while addicted pregnant women and their foetus have a high benefit from appropriate replacement therapy. However, the recommendations concerning breast feeding during an opioid replacement therapy are discussed controversially, because methadone as well as buprenorphine accumulate in breast milk. This accumulation might cause damages to the newborn’s health; so, child benefits of breast feeding have to be balanced with possible health risks.

Methods:

This review provides an overview of a selective literature search based on the PubMed-database and german consensus recommendations. Used search terms included: (methadone*) AND (breastfeeding OR lactation), (methadone*) AND (human milk), (buprenorphine*) AND (breastfeeding OR lactation) and (buprenorphine*) AND (human milk).

Results:

According to the available literature, addicted women, substinated with methadone or buprenorphine are allowed to breast feed their newborns. The advantages of breast feeding prevail the risks of an infant opiate intoxication caused by methadone or buprenorphine.

Schlüsselwörter

Stillen - Schwangerschaft - Drogenkonsum - Methadon - Buprenorphin

Key words

breast feeding - pregnancy - drug addiction - methadone - buprenorphine
 

  • Literatur

  • 1 Abdel-Latif ME, Pinner J, Clews S et al. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006; 117: e1163-1169
    CrossrefPubMedGoogle Scholar
  • 2 Abrahams RR, Kelly SA, Payne S et al. Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physician 2007; 53: 1722-1730
    Google Scholar
  • 3 Ballard JL. Treatment of neonatal abstinence syndrome with breast milk containing methadone. J Perinat Neonatal Nurs 2002; 15: 76-85
    PubMedGoogle Scholar
  • 4 Begg EJ, Malpas TJ, Hackett LP et al. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol 2001; 52: 681-685
    CrossrefPubMedGoogle Scholar
  • 5 Blinick G, Inturrisi CE, Jerez E et al. Methadone assays in pregnant women and progeny. Am J Obstet Gynecol 1975; 121: 617-621
    PubMedGoogle Scholar
  • 6 Bundesopiumstelle. Bundesinstitut für Arzneimittel und Medizinprodukte. Bonn http://www.bfarm.de/SharedDocs/1_Downloads/DE/Bundesopiumstelle/BtM/substit-reg/Subst_Bericht_2010.pdf?_blob=publicationFile 2011;
    PubMedGoogle Scholar
  • 7 Statistisches Bundesamt Deutschland. 2008: Mehr Sterbefälle und Eheschließungen, etwas weniger Geburten. Pressemitteilung Nr 137 vom 07.04.2009, Wiesbaden http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Presse/pm/2009/04/PD09_137_126,templateId=renderPrint.psml 2009;
    PubMedGoogle Scholar
  • 8 Dryden C, Young D, Hepburn M et al. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 2009; 116: 665-671
    CrossrefPubMedGoogle Scholar
  • 9 Fischer M, Reimer J, Schafer I et al. (Status quo of opioid agonist maintenance therapy in Germany). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53: 332-339
    PubMedGoogle Scholar
  • 10 Garrido MJ, Troconiz IF. Methadone: a review of its pharmacokinetic/pharmacodynamic properties. J Pharmacol Toxicol Methods 1999; 42: 61-66
    CrossrefPubMedGoogle Scholar
  • 11 Geraghty B, Graham EA, Logan B et al. (Methadone levels in breast milk). J Hum Lact 1997; 13: 227-230
    CrossrefPubMedGoogle Scholar
  • 12 Grimm D, Pauly E, Poschl J et al. Buprenorphine and norbuprenorphine concentrations in human breast milk samples determined by liquid chromatography-tandem mass spectrometry. Ther Drug Monit 2005; 27: 526-530
    CrossrefPubMedGoogle Scholar
  • 13 Hirose M, Hosokawa T, Tanaka Y. Extradural buprenorphine suppresses breast feeding after caesarean section. Br J Anaesth 1997; 79: 120-121
    CrossrefPubMedGoogle Scholar
  • 14 Huppertz-Kessler CJ, Verveur D, Poschl J. [To what degree does the NICU environment influence neurodevelopment of preterm infants?]. Klin Padiatr 2010; 222: 236-242
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Isemann B, Meinzen-Derr J, Akinbi H. Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol 2011; 31: 25-29
    CrossrefPubMedGoogle Scholar
  • 16 Jansson LM, Choo R, Velez ML et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008; 121: 106-114
    CrossrefPubMedGoogle Scholar
  • 17 Jansson LM, Choo R, Velez ML et al. Methadone maintenance and long-term lactation. Breastfeed Med 2008; 3: 34-37
    CrossrefPubMedGoogle Scholar
  • 18 Jansson LM, Choo RE, Harrow C et al. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. J Hum Lact 2007; 23: 184-190
    CrossrefPubMedGoogle Scholar
  • 19 Jansson LM, Velez M, Harrow C. Methadone maintenance and lactation: a review of the literature and current management guidelines. J Hum Lact 2004; 20: 62-71
    CrossrefPubMedGoogle Scholar
  • 20 Jones HE, Martin PR, Heil SH et al. Treatment of opioid-dependent pregnant women: clinical and research issues. J Subst Abuse Treat 2008; 35: 245-259
    CrossrefPubMedGoogle Scholar
  • 21 Konsensustext. Empfehlungen zur Anwendung von Buprenorphin (Subutex®) in der Substitutionsbehandlung opiatabhängiger Patienten in der Schweiz, Österreich und Deutschland. Suchtmedizin in Forschung und Praxis 2000; 2: 43-53
    PubMedGoogle Scholar
  • 22 Kreek MJ. Methadone disposition during the perinatal period in humans. Pharmacol Biochem Behav 1979; 11 (Suppl) 7-13
    PubMedGoogle Scholar
  • 23 Kreek MJ, Schecter A, Gutjahr CL et al. Analyses of methadone and other drugs in maternal and neonatal body fluids: use in evaluation of symptoms in a neonate of mother maintained on methadone. Am J Drug Alcohol Abuse 1974; 1: 409-419
    CrossrefPubMedGoogle Scholar
  • 24 Lejeune C, Simmat-Durand L, Gourarier L et al. Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenophine substitution. Drug Alcohol Depend 2006; 82: 250-257
    CrossrefPubMedGoogle Scholar
  • 25 Lindemalm S, Nydert P, Svensson JO et al. Transfer of buprenorphine into breast milk and calculation of infant drug dose. J Hum Lact 2009; 25: 199-205
    CrossrefPubMedGoogle Scholar
  • 26 Marquet P, Chevrel J, Lavignasse P et al. Buprenorphine withdrawal syndrome in a newborn. Clin Pharmacol Ther 1997; 62: 569-571
    CrossrefPubMedGoogle Scholar
  • 27 McCarthy JJ, Posey BL. Methadone levels in human milk. J Hum Lact 2000; 16: 115-120
    CrossrefPubMedGoogle Scholar
  • 28 Nentwich I, Pazdirkova A, Lokaj J et al. [Early feeding in infancy and atopic dermatitis – a prospective observational study]. Klin Padiatr 2009; 221: 78-82
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Philipp BL, Merewood A, O’Brien S.. Methadone and breastfeeding: new horizons. Pediatrics 2003; 111: 1429-1430
    CrossrefPubMedGoogle Scholar
  • 30 Pond SM, Kreek MJ, Tong TG et al. Altered methadone pharmacokinetics in methadone-maintained pregnant women. J Pharmacol Exp Ther 1985; 233: 1-6
    PubMedGoogle Scholar
  • 31 Unger A, Jung E, Winklbaur B et al. Gender issues in the pharmacotherapy of opioid-addicted women: buprenorphine. J Addict Dis 2010; 29: 217-230
    CrossrefPubMedGoogle Scholar
  • 32 Wachman EM, Byun J, Philipp BL. Breastfeeding rates among mothers of infants with neonatal abstinence syndrome. Breastfeed Med 2010; 5: 159-164
    CrossrefPubMedGoogle Scholar
  • 33 Wojnar-Horton RE, Kristensen JH, Yapp P et al. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997; 44: 543-547
    PubMedGoogle Scholar