For breastfeeding, all H2 blockers are compatible, but human experience is limited. Cimetidine and ranitidine are concentrated in milk with concentrations much higher than those in maternal plasma. Famotidine also is concentrated in milk, but to a lesser degree, and the data for nizatidine are too limited to assess. The human data for lansoprazole and omeprazole are limited to one case report. The premature male infant (36 weeks) was breastfed while his mother continued her GERD treatment with omeprazole 20 mg/day. No harm was noted in the infant, who was doing well at 1 year of age. Theoretically, any of these agents could adversely affect a nursing infant’s gastric acidity and have other potentially harmful effects, but such toxicity has not been reported. Nevertheless, because of their potency, avoiding PPIs during breastfeeding should be considered.
Mr. Gerald G. Briggs is a pharmacist clinical specialist at the outpatient clinics of Memorial Care Center for Women at Miller Children’s Hospital in Long Beach, Calif.; a clinical professor of pharmacy at the University of California, San Francisco; and an adjunct professor of pharmacy at the University of Southern California, Los Angeles, and Washington State University, Spokane. He also is coauthor of "Drugs in Pregnancy and Lactation," and coeditor of "Diseases, Complications, and Drug Therapy in Obstetrics." He said he had no relevant financial disclosures. E-mail him at obnews@elsevier.com.