Εφεδρίνη

An alkaloid derived from ephedra. It has sympathomimetic properties with direct and indirect effects on adrenergic receptors. Used parenterally to treat hypotension derived from spinal or epidural anesthesia due to its peripheral vasoconstrictor effects and improvement of heart tone. Used orally as a bronchodilator and nasal decongestant mixed in preparations for colds, bronchitis and asthma. Topical use: local anesthetic, dermatological, stomatological and ophthalmological. Used illegaly as a psychostimulant and for weight loss, with serious health risks. ^{(van der Hoof 2002, Gruber 1998)}

Since the last update we have not found published data on its excretion in breast milk.

Its large volume of distribution makes it unlikely it will pass into milk in significant amounts.

After a cesarean section with epidural anesthesia and use of ephedrine there were no side effects in 100 newborns; the time of initial breastfeeding was not delayed with respect to newborns after cesareans under general anesthesia ^{(Havas 2013)}. The use of ephedrine during delivery or cesarean section is not contraindicated with the early initiation of breastfeeding: as well as the unlikely excretion in breast milk there is a low amount of colostrum obtained by the newborn in the first hours of life.

It may be desirable to minimize the continued use of oral preparations for colds/bronchitis which contain ephedrine since a case of crying, irritability and insomnia has been reported in a 3-month-old infant whose mother was taking a medication containing d-isoephedrine and dexbrompheniramine.^{(Mortimer 1977)}

Simple preparations (a single active ingredient per drug) are preferable and even more so during breastfeeding. Abusive use as a psychostimulant or antiobesity product entails serious risks to the health of the mother and the infant and should be avoided. ^{(van der Hoof 2002, Gruber 1998)}

There is good quality evidence that exclusive breastfeeding helps to regain pre-pregnancy weight earlier than if breastfeeding is partial (mixed) or there is no breastfeeding, and that prolonged breastfeeding helps maintain that loss and as well as body fat loss.^{(Jayasinghe 2021, Schalla 2017, López 2016, Jarlenski 2014, Sámano 2013, Neville 2014, Hatsu 2008, Dewey 2004, 2001 y 1993, Kramer 1993)}

Some authors consider oral and nasal decongestant drugs dispensable drugs, to be avoided in general, not only during lactation, since they expose patients to serious risks (cardiovascular, neurological and intestinal) to treat a benign alteration such as nasal obstruction , which usually progresses favorably in a few days without medication. ^{(Prescrire 2018)}

TOPICAL USE:

Correctly applied topical ephedrine preparations have virtually no systemic absorption. ^{(AEMPS 2008)}

Avoid applying it on the breast, otherwise, cleanse the area thoroughly and/or do it after having nursed.

Ephedrine as a complement to preparations for local anesthetic, dermatologicals, stomatologicals or ophthalmologicals is compatible with breastfeeding. ^{(WHO 2002)}

See below the information of these related products:

• Cytisine (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
• Ephedra (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)