A member of DOCS Education writes:
My patient is a nursing mother. She is 32 and requires approximately 5 hours of treatment, including operative and periodontal. The woman’s medical history reveals ulcerative colitis, anemia and migraines.
The woman’s daily medications are extensive. She takes Colazal® and undergoes a Rowasa® enema daily for the ulcerative colitis. Zoloft® and hydrocodone address the migraines. Other recurring substances are basic calcium phosphate crystals (BCP) and prenatal vitamins.
In 2009 the patient was sedated for 3.5 hours of restoration dentistry. The regimen was 100 mg oral hydroxyzine and 0.50 mg triazolam (0.25 one hour pre-operative followed by 0.25 mg when she arrived at the office).
The 2012 Ultimate Cheat Sheet contains a special page for nursing mothers. It emphatically says no to all benzodiazepines. Is there a safe protocol for this patient? I regularly use midazolam and fentanyl.
Dr. Lesley Fang, Medical Director of DOCS Education Faculty, responds:
You are absolutely correct. The Ultimate Cheat Sheet guidelines prohibit benzodiazepines for nursing mothers because these cross the milk barrier readily and expose the infant. (You do not want to sedate the child, of course.)
Fortunately you can make provisions by saving the mother’s milk. Have your patient pump the day before. She can use that milk to feed the baby. She should pump and discard milk created on the day of sedation. She simply resumes normal feeding the following day.
Dr. Anthony Feck, Dean of DOCS Education Faculty, adds:
What Dr. Fang has outlined is correct. Pump and dump the day of the appointment and continue normal feeding 24 hours after the last sedation dose.
Despite the fact that this child already receives antidepressants and opiate analgesics through nursing, there’s no need to add sedative/hypnotic agents to the mix.