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Dinoprostone use while Breastfeeding

Drugs containing Dinoprostone: Cervidil, Prostin E2, Prepidil

Dinoprostone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Dinoprostone (prostaglandin E2) has not been measured in human milk after exogenous administration, but it is a normal component of breastmilk in small amounts where it may help protect the infant's gastrointestinal tract.

Given orally in the first few days postpartum, dinoprostone can suppress lactation. Whether vaginal or endocervical administration might suppress lactation if given postpartum is not known, but it should probably not be used postpartum in mothers who wish to breastfeed. By one month postpartum, the drug appears not to suppress lactation.

Drug Levels

Maternal Levels. Milk levels of dinoprostone have not been measured after exogenous administration to humans. However, it is a normal component of breastmilk, where it may play a role in protecting the infant's gastrointestinal tract.[1][2][3][4][5][6][7] Normal concentrations in milk vary widely over a range up to about 500 ng/L, but appear to be similar to the maternal plasma concentrations.[5]

Vaginal or endocervical administration of dinoprostone for induction of labor produces maternal serum concentrations about double the normal levels,[8][9] so milk concentrations are likely to be comparably higher following exogenous administration.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Dinoprostone has been used investigationally to inhibit postpartum lactation and engorgement by reducing serum prolactin concentrations.[10][11][12][13][14] The effect on prolactin levels, engorgement and lactation appears to be dose and duration related, with a dosage of 3 mg daily for 4 days[15] or 0.5 mg three times daily being ineffective.[14] Dosages of 8 to 12 mg over 24 to 30 hours were effective.[10][12] These effects seem to be limited to the first few days postpartum; dinoprostone had no effect on serum prolactin or milk production when given to women 30 days postpartum.[10] Compared to bromocriptine 2.5 mg every 12 hours for 14 days, dinoprostone 12 mg in divided doses over 30 hours was as effective as bromocriptine, but resulted in less rebound breast tenderness.[12]

References

1. Lucas A, Mitchell MD. Prostaglandins in human milk. Arch Dis Child. 1980;55:950-2. PMID: 7458394

2. Neu J, Wu-Wang CY, Measel CP, Gimotty P. Prostaglandin concentrations in human milk. Am J Clin Nutr. 1988;47:649-52. PMID: 3162635

3. Hawkes JS, Bryan DL, James MJ, Gibson RA. Cytokines (Il-1beta, Il-6, TNF-alpha, TGF-beta1, and TGF-beta2) and prostaglandin E2 in human milk during the first three months postpartum. Pediatr Res. 1999 ;46:194-9. PMID: 10447115

4. Le Deist F, De Saint-Basile G, Angeles-Cano E, Griscelli C. Prostaglandin E2 and plasminogen activators in human milk and their secretion by milk macrophages. Am J Reprod Immunol Microbiol. 1986;11:6-10. PMID: 3461715

5. Shimizu T, Yamashiro Y, Yabuta K. Prostaglandin E1, E2, and F2 alpha in human milk and plasma. Biol Neonate. 1992;61:222-5. PMID: 1610950

6. Alzina V, Puig M, de Echaniz L et al. Prostaglandins in human milk. Biol Neonate. 1986;50:200-4. PMID: 3465374

7. Reid B, Smith H, Friedman Z. Prostaglandin in human milk. Pediatrics. 1980;66:870-2. PMID: 7454478

8. Goharkhay N, Stanczyk FZ, Gentzschein E, Wing DA. Plasma prostaglandin E(2) metabolite levels during labor induction with a sustained-release prostaglandin E(2) vaginal insert. J Soc Gynecol Investig. 2000;7:338-42. PMID: 11111068

9. Siqueira M, Neves J, Arteaga M et al. [Plasma prostaglandin E2 in pregnant women undergoing labor induction with endocervical gel application]. Rev Esp Med Nucl. 1999;18:268-71. PMID: 10481108

10. Caminiti F, De Murtas M, Parodo G et al. Decrease in human plasma prolactin levels by oral prostaglandin E2 in early puerperium. J Endocrinol. 1980;87:333-7. PMID: 7452120

11. Beric B, Mitreski A, Kuzmancev O et al. [Inhibition of initial puerperal and postpartum lactation using oral prostaglandin E2 (dinoprostone)]. Med Pregl. 1992;45:421-6. PMID: 1344441

12. England MJ, Tjallinks A, Hofmeyr J, Harber J. Suppression of lactation. A comparison of bromocriptine and prostaglandin E2. J Reprod Med. 1988;33:630-2. PMID: 3172062

13. Nasi A, de Murtas M, Parodo G, Caminiti F. Inhibition of lactation by prostaglandin E2. Obstet Gynecol Surv. 1979;35:619-20. PMID: 7413116

14. Grunberger W. [Postpartum uterus involution and lactation levels in randomized comparison between prostin E2 tablets and methergine dragees]. Gynakol Rundsch. 1983;23:100-7. PMID: 6347832

15. Tulandi T, Gelfand MM, Maiolo LM. Effect of prostaglandin E2 on puerperal breast discomfort and prolactin secretion. J Reprod Med. 1985;30: 176-8. PMID: 3858547

Dinoprostone Identification

Substance Name

Dinoprostone

CAS Registry Number

363-24-6

Drug Class

Oxytocics

Prostaglandins

Administrative Information

LactMed Record Number

738

Last Revision Date

20140801

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