Breast-feeding

Tretinoin

According to the manufacturers, breast-feeding should be discontinued prior to receiving oral tretinoin and caution should be used with topical tretinoin.(50)(49) It is unknown whether oral or topical tretinoin is distributed into breast milk. Systemic absorption of tretinoin after topical application is low (49), and therefore it is unlikely that a significant amount of the drug is excreted into breast-milk. However, consideration for the use of an alternative topical agent (e.g., azelaic acid, benzoyl peroxide, clindamycin, erythromycin) may be appropriate for some patients. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.

Niacinamide

According to a manufacturer of niacin (Niaspan), although no studies have been conducted in nursing mothers, excretion into human milk is expected. The manufacturer recommends the discontinuation of nursing or the drug due to serious adverse reactions that may occur in nursing infants from lipid-altering doses of nicotinic acid.(2) Niacin, in the form of niacinamide, is excreted in breast milk in proportion to maternal intake. Niacin supplementation is only needed in those lactating women who do not have adequate dietary intake. The Recommended Daily Allowance (RDA) of the National Academy of Science for niacin during lactation is 20 mg.(40) There are no safety data regarding the use of nicotinic acid in doses above the RDA during breast-feeding. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

Vitamin E Acetate

Vitamin E crosses the placenta and is distributed into breast milk. The amount of vitamin E that crosses the placenta appears to be less than the amount transferred to the infant via breast milk. Vitamin E concentrations in human colostrum range from 0.13 to 3.6 mg per 100 mL. The amounts in human milk range from 0.1 to 0.48 per 100 mL. Use of vitamin E within the recommended daily dietary intake for lactating women is generally recognized as safe. Oral supplementation of vitamin E during breast-feeding should be approached with caution. Vitamin E deficiency is rare, and supplementation of vitamin E specifically during lactation is not necessary for females with normal fat absorption. Topically applying vitamin E to the breasts should be avoided as it could theoretically expose the infant to additional oral vitamin E.(7)(45) Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.