Is Purg-odan (sodium picosulfate) safe to use during breastfeeding?

Safety of Purg-odan (Sodium Picosulfate) During Breastfeeding

Sodium picosulfate (Purg-odan) is safe to use during breastfeeding as the active metabolite remains below detectable limits in breast milk, posing minimal risk to the breastfed infant. 1

Evidence on Sodium Picosulfate Safety

• According to the FDA drug label, published data on lactating women indicate that the active metabolite of sodium picosulfate, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), remained below the limit of detection (1 ng/mL) in breast milk after both single and multiple doses of 10 mg/day 1
• The FDA states that there are no data on the effects of sodium picosulfate on the breastfed infant or on milk production, but the drug is not contraindicated during breastfeeding 1
• The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for the medication 1

Principles of Medication Safety During Breastfeeding

• Most commonly used drugs are relatively safe for breastfed babies, with doses received via milk generally small and much less than known safe doses given directly to infants 2
• The amount of medication that enters breast milk varies based on maternal serum concentration and pharmacologic properties of the medication 3
• When prescribing medications for breastfeeding patients, those with the lowest risk to the infant should be selected 3

Factors Affecting Drug Transfer into Breast Milk

• Molecular weight: Larger molecules have difficulty passing into breast milk 4
• Plasma protein binding: Higher protein binding means less free drug available to diffuse into milk 4
• Drug half-life: Shorter half-life drugs pose less risk of accumulation in the infant 4
• Relative infant dose: A drug with proportion <10% of maternal dose is considered to be the preferred option 4

Recommendations for Laxative Use During Breastfeeding

• Laxatives that are not systemically absorbed are considered safest for use during breastfeeding 5
• Short-term use of most gastrointestinal medications, including laxatives, is generally acceptable during breastfeeding 5
• The American Academy of Pediatrics lists certain laxatives like senna and cascara as compatible with breastfeeding 5

Practical Considerations

• If concerned about potential effects, timing medication administration to just after breastfeeding can minimize infant exposure 3
• Monitor the infant for any unusual symptoms such as changes in stool pattern, irritability, or poor feeding 4
• Non-pharmacological approaches for constipation (increased fluid intake, dietary fiber) can be considered as first-line options 6

Important Caveats

• While sodium picosulfate appears safe during breastfeeding, each mother-infant pair is unique, and individual factors should be considered 7
• The benefits of treating the mother's condition while maintaining breastfeeding generally outweigh theoretical risks of medication exposure through breast milk 2, 7
• If the mother requires ongoing laxative therapy, consultation with a healthcare provider experienced in breastfeeding medicine may be helpful 8