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Coumarin derivatives and breast-feeding
S L Clark1, T F Porter, F G West
1Intermountain Health Care, The University of Utah School of Medicine, Salt Lake City, Utah, USA. ldsclark@ihc.com
Obstetrics and Gynecology
|June 1, 2000
Summary
Coumarin anticoagulants, commonly used in the US, have controversial use in breastfeeding women. Warfarin sodium is not excreted into breast milk and is safe for postpartum anticoagulation.
Area of Science:
- Pharmacology
- Obstetrics & Gynecology
- Neonatal Medicine
Background:
- Coumarin derivatives are widely prescribed anticoagulants in the United States.
- Their use during pregnancy is relatively contraindicated, and safety in breastfeeding women remains controversial.
- Confusion regarding passage into breast milk may arise from varying chemical properties among different coumarin agents.
Purpose of the Study:
- To clarify the safety of coumarin derivative anticoagulants in breastfeeding women.
- To evaluate the excretion of specific coumarin agents into breast milk.
- To provide guidance on anticoagulant selection for postpartum women requiring therapeutic anticoagulation.
Main Methods:
- Review of chemical structures of various coumarin derivatives.
- Analysis of available clinical evidence and pharmacokinetic data.
- Assessment of drug transfer into human breast milk.
Main Results:
- Warfarin sodium, a common coumarin derivative, is not significantly excreted into breast milk.
- Available clinical evidence supports the safety of warfarin sodium for breastfeeding women.
- Dicumarol is a preferred alternative to anisindione for patients unable to tolerate warfarin sodium.
Conclusions:
- Warfarin sodium can be safely administered to breastfeeding women requiring therapeutic anticoagulation.
- The chemical properties of coumarin derivatives influence their excretion into breast milk.
- For alternative anticoagulation, dicumarol is recommended over anisindione in breastfeeding postpartum patients.