Watanabe Chiho, Wachi Toru, Kamada Shoko, Kawano Susumu, Taguchi Shin
Department of Clinical Pharmacy, Japanese Red Cross Society Akita Hospital, Akita, JPN.
Pharmacy, Pharma Mirai Co. Ltd. Co-creation Future Citizen Pharmacy, Niigata, JPN.
Cureus. 2025 Aug 3;17(8):e89301. doi: 10.7759/cureus.89301. eCollection 2025 Aug.
This study aimed to measure the concentrations of amiodarone (AM) and its active metabolite, mono--desethylamiodarone (DEA), in the breast milk of postpartum Japanese women treated with AM for ventricular tachycardia associated with peripartum cardiomyopathy and to conduct a follow-up study on the long-term growth and development of infants after resumption of breastfeeding. The patient was a 28-year-old Japanese woman with no underlying diseases who developed ventricular tachycardia and peripartum cardiomyopathy after giving birth. She was administered AM for three days via a combination of oral and intravenous administration. Breastfeeding began 35 days after the end of AM. Breast milk was collected 14 and 39 days after the end of AM, and its concentration in breast milk was measured using high-performance liquid chromatography. Furthermore, the growth and developmental test results of the twins were tracked for three years. Fourteen days after the end of AM administration, the AM concentration in breast milk was 111 ng/mL and the DEA concentration was 143 ng/mL. After 39 days, the AM concentration in breast milk was 11.8 ng/mL, and the DEA concentration in breast milk was 36.6 ng/mL. Studies have reported that pregnant women receiving AM are at risk of causing infant hypothyroidism and developmental delays due to the drug's high iodine content. Given the potential risks of invasive procedures and low milk intake, thyroid function testing was not conducted in the infant. Both twins were noted to be obese but had no clinical complications, and developmental evaluations showed no deficits. It was believed that resuming breastfeeding at that time was appropriate. Considering the risks associated with hypothyroidism, it is necessary to carefully determine the timing of breastfeeding initiation based on factors such as the mother's AM dosage, maternal blood concentration, and the infant's breast milk intake. However, it is considered acceptable for breastfeeding women who have received oral or intravenous AM for several days postpartum to breastfeed their infants.
本研究旨在测量产后接受胺碘酮（AM）治疗围产期心肌病相关室性心动过速的日本女性母乳中胺碘酮（AM）及其活性代谢物单去乙基胺碘酮（DEA）的浓度，并对恢复母乳喂养后婴儿的长期生长发育进行随访研究。患者为一名28岁无基础疾病的日本女性，产后出现室性心动过速和围产期心肌病。她通过口服和静脉联合给药方式接受了三天的胺碘酮治疗。胺碘酮治疗结束35天后开始母乳喂养。在胺碘酮治疗结束后14天和39天收集母乳，采用高效液相色谱法测定母乳中其浓度。此外，对这对双胞胎的生长发育测试结果进行了三年的跟踪。胺碘酮给药结束14天后，母乳中胺碘酮浓度为111 ng/mL，单去乙基胺碘酮浓度为143 ng/mL。39天后，母乳中胺碘酮浓度为11.8 ng/mL，母乳中单去乙基胺碘酮浓度为36.6 ng/mL。有研究报道，接受胺碘酮治疗的孕妇因药物碘含量高，有导致婴儿甲状腺功能减退和发育迟缓的风险。鉴于侵入性检查的潜在风险和低奶量摄入，未对婴儿进行甲状腺功能检测。注意到这对双胞胎均肥胖，但无临床并发症，发育评估无缺陷。当时认为恢复母乳喂养是合适的。考虑到与甲状腺功能减退相关的风险，有必要根据母亲的胺碘酮剂量、母体血药浓度和婴儿的母乳摄入量等因素仔细确定开始母乳喂养的时间。然而，产后接受口服或静脉胺碘酮治疗数天的母乳喂养女性对其婴儿进行母乳喂养被认为是可以接受的。
