Adrenaline Acid Tartrate

Adrenaline or epinephrine is a hormone and neurotransmitter used to treat allergic reactions, asthma, restore heart rhythm, control mucosal congestion, and glaucoma. Used as a systemic drug for cardiac resuscitation, asthma and anaphylaxis and locally in topical anesthetic preparations, epidural anesthesia, eye drops (mydriatic), and nasal drops (vasoconstrictor).

At last update no published data on excretion in breast milk were found.

Its rapid metabolism (short Tmax and T½, less than 5 minutes) makes it very unlikely an excretion into milk in significant amounts.

Furthermore, it is destroyed in the gastrointestinal tract. The low oral-bioavailability makes its levels into infant's plasma, that would be absorbed from ingested breast milk, be nil or negligible. ^{(Nice 2000)}

No problems have been observed in infants of mothers treated with adrenaline. ^{(Shanks 2009)}

Local infiltration of lidocaine and epinephrine into the caesarean section wound allowed an earlier initiation of lactation than with lidocaine alone. ^{(Tharwat 2016)}

Maintained high intravenous doses decrease milk production by interfering with the secretion of prolactin ^{(Nicoletti 1984)}, especially the early postpartum-weeks, because when breastfeeding is well established, prolactin levels do not correlate with milk production any longer.

No problems related to lactation have been observed due to epidural anesthesia in which epinephrine is used. ^{(Chang 2005, Radzyminski 2003)}

Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs: compatible with breastfeeding. ^{(WHO-UNICEF 2002)}

TOPICAL USE:

The small dose and poor plasma absorption of most topical dermatological, nasal and ophthalmic  preparations make it unlikely that a significant amount will pass into breast milk. ^{(Butler 2014)}

In ophthalmological use, systemic absorption should be minimized by pressing the tear duct (inner corner of the eye) with the finger for 1 to 2 minutes and administering the dose immediately after breastfeeding. ^{(Belkin 2020, Blumen 2020, Méndez 2012)}