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An infant was born at 33+2 weeks gestation by caesarean section after an in utero diagnosis of fetal ascites and tachycardia. The mother had received treatment during pregnancy with flecainide, amiodarone, and propranolol. The amiodarone was prescribed initially at 200 mg three times a day and was reduced to twice a day after 11 days.
The mother was keen to breast feed the baby. In previous reports of amiodarone and breast feeding, amiodarone treatment was for a maternal indication and hence continued post partum.1,2 In this case, the amiodarone treatment stopped at delivery. However, because of the long terminal half life of amiodarone (about 50 days3), it could take several months for the level to fall. As one of the adverse effects of amiodarone is thyroid toxicity, the baby’s thyroid function was assessed and found to be normal. A decision was made to allow the mother to breast feed, and the baby was closely monitored.
Breast milk was sent for analysis to determine the amiodarone level on days 5, 11, 18, and 25. It had increased on day 11 (2.1 mg/l) compared with day 5 (0.6 mg/l). This may be due to changes in composition of the milk. We do not know at what time of day the milk was expressed or whether the sample was taken at the beginning or the end of the feed. The fat content of the milk was likely to be greater after 11 days than after 5 days, which may affect the distribution of amiodarone. McKenna et al4 described changes in amiodarone concentration in breast milk throughout the day. By 25 days, amiodarone was undetectable. Throughout this period the baby remained well and thyroid function was normal.
Although we would not recommend that breast feeding is necessarily safe for all babies exposed to amiodarone, this case illustrates that, in some circumstances, with close monitoring, breast feeding can be initiated.