Celecoxib for back pain when breastfeeding.

[exSAgrad]

Queried a script today as manufacturer says to avoid. Does anyone know how harmful it is to baby? Patient had been taking diclofenac and omeprazole before this.

[Mensfuff]

Queried a script today as manufacturer says to avoid. Does anyone know how harmful it is to baby? Patient had been taking diclofenac and omeprazole before this.

Research shows that small molecules (most likley prostaglandins) are resposible for foetal breathing; as inhibition of prostaglandin synthesis with indometacin caused an decrease in foetal breathing.

Also; The BNF states that

"With regular use closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. Delayed onset and increased duration of labour"

To avoid either of these effects, i would try and replace therapy with NSAID's to using something topical if possible (rubefacients, Lidocaine patches) or try acupuncture or another alternative non-pharmacological treatment (assuming paracetamol doesn't cover the pain threshold)

[exSAgrad]

Research shows that small molecules (most likley prostaglandins) are resposible for foetal breathing; as inhibition of prostaglandin synthesis with indometacin caused an decrease in foetal breathing.

Also; The BNF states that

"With regular use closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. Delayed onset and increased duration of labour"

To avoid either of these effects, i would try and replace therapy with NSAID's to using something topical if possible (rubefacients, Lidocaine patches) or try acupuncture or another alternative non-pharmacological treatment (assuming paracetamol doesn't cover the pain threshold)

Thankyou for your reply, the Dr in this case tried to persuade the lady to carry on with the celecoxib "as less theoretical risk to breastfed baby than diclofenac" but patient went back to latter.

[Shwampa]

Thanks Menasfuff..the query was about breastfeeding and not pregnancy.

Br J Clin Pharmacol. 2006 January; 61(1): 101–104.
doi: 10.1111/j.1365-2125.2005.02520.x. PMCID: PMC1884977

Copyright © 2005 Blackwell Publishing Ltd
Quantification of infant exposure to celecoxib through breast milk
Sharon J Gardiner,1,2 Matthew P Doogue,1 Mei Zhang,2 and Evan J Begg1,2

Aims

To determine the milk-to-plasma (M/P) concentration ratio of celecoxib, and estimate likely infant exposure.

Methods

Blood and milk were sampled for 48 h after oral administration of celecoxib 200 mg to six lactating volunteers. The M/P ratio was derived from the area under the concentration–time curves (0–∞) and the infant ‘dose’ estimated from celecoxib concentrations in milk.
Results

The median (range) M/P ratio was 0.18 (0.15–0.26). The median (range) infant ‘dose’ was 0.23% (0.17–0.30%) of the maternal dose, adjusted for weight.

Conclusion

The relative ‘dose’ of celecoxib to which infants are exposed via milk is very low, suggesting that breastfeeding during routine dosing would pose minimal risk.