title: Narcolepsy Treated with Racemic Amphetamine during Pregnancy and Breastfeeding.
abstract: This case report describes a woman with narcolepsy treated with racemic amphetamine (rac-amphetamine) during pregnancy and breastfeeding with follow-up on the infant's development up to 10 months of age. The pregnancy outcome and the pharmacokinetics of rac-amphetamine were studied during breastfeeding. The pregnancy and the delivery were uneventful. Concentrations of rac-amphetamine were determined in the plasma of the mother and infant, and in the breast milk with a liquid chromatography-mass spectrometry method. Samples were obtained at 2, 5, and 9 weeks postpartum. The transfer of rac-amphetamine to the breast milk was extensive (mean milk/maternal plasma concentration ratio approximately 3). The breastfed infant had a low plasma concentration of rac-amphetamine (about 9% of the maternal plasma level) and the calculated relative infant dose was low (2%). No adverse effects were observed in the breastfed infant. The infant's somatic and psychomotor development up to 10 months of age was normal. Further studies of amphetamine prescribed for medical reasons during pregnancy and lactation are needed.
authors.affiliation: Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden inger.ohman@ki.se.
authors.forename: Inger
authors.initials: I
authors.lastname: Öhman
authors.affiliation: Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Birgitta Norstedt
authors.initials: BN
authors.lastname: Wikner
authors.affiliation: Department of Laboratory Medicine, Section of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Beck
authors.affiliation: Department of Clinical Science and Education, Karolinska University Hospital, Sachs Children's Hospital, Södersjukhuset, Stockholm, Sweden.
authors.forename: Ihsan
authors.initials: I
authors.lastname: Sarman
mesh_terms: D000328:Adult; D000661:Amphetamine / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D001942:Breast Feeding; D000697:Central Nervous System Stimulants / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D002657:Child Development / Q000187:drug effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008895:Milk, Human / Q000737:chemistry*; D009290:Narcolepsy / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*
chemical_list: D000697:Central Nervous System Stimulants; D000661:Amphetamine
keywords: amphetamine; breastfeeding; lactation; narcolepsy; pharmacokinetics; pregnancy