Pharmacokinetics and Safety of Commonly Used Drugs in Lactating Women and Breastfed Infants

January 24, 2024 updated by: Kanecia Obie Zimmerman, Duke University
Over half of women in the US who are breastfeeding their infants take prescription drugs. You are being asked to participate in this study because you are breastfeeding your infant and are currently taking, as part of your medical care, at least one of the drugs we are studying. We are interested in studying drugs commonly prescribed to women who are breastfeeding so we can learn more about the amount of drug that is transferred to breastmilk and estimate how much of drug that is consumed by breastfed infants.

Study Overview

Detailed Description

The purpose of this study is to understand if the study drugs of interest are found in breastmilk and how much; to estimate the amount of drug that is consumed by breastfed infants and what effect this may have on infants; and to share what we learn with other researchers. The study drugs of interest have Food and Drug Administration (FDA) approval, but there is little or no information about the amount of drug found in the breastmilk of mothers who take them; the amount of drug that may be transferred to their infant's through breastmilk; or the effects this transfer may have on their infants. During this study we will ask to collect breastmilk and blood from mothers, and blood from infants, to measure the amount of study drug of interest in these body fluids. Results from this study will help researchers better understand how much of the study drug of interest is in your blood and breastmilk, and how much of the study drug of interest may be in your infant's blood because of breastfeeding.

Study Type

Observational

Enrollment (Estimated)

1600

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

    • Ontario
      • London, Ontario, Canada, N6A 5W9
        • Completed
        • Lawson Health Research Institute
    • Quebec
      • Montréal, Quebec, Canada, H3T IC5
        • Completed
        • Centre Hospitalier Universitaire Sainte-Justine
    • California
      • La Jolla, California, United States, 92093
        • Recruiting
        • University of California-San Diego Medical Center
        • Contact:
        • Contact:
        • Principal Investigator:
          • Christina Chambers, PhD
        • Sub-Investigator:
          • Michelle Leff
      • Loma Linda, California, United States, 92354
        • Recruiting
        • Loma Linda University Health
        • Contact:
        • Contact:
        • Sub-Investigator:
          • Adrian Lavery
        • Principal Investigator:
          • Larry Ngo
    • Illinois
      • Chicago, Illinois, United States, 60614
        • Recruiting
        • Ann and Robert H. Lurie Childrens Hospital of Chicago
        • Contact:
        • Contact:
        • Principal Investigator:
          • William Muller, MD
      • Chicago, Illinois, United States, 60611
        • Completed
        • Northwestern University
    • Indiana
      • Indianapolis, Indiana, United States, 46202
        • Completed
        • Indiana University Health
    • Iowa
      • Iowa City, Iowa, United States, 52242
        • Recruiting
        • University of Iowa Hospitals and Clinics
        • Contact:
        • Contact:
        • Principal Investigator:
          • Temitope Awelewa, MD
    • Minnesota
      • Minneapolis, Minnesota, United States, 55404
    • New Mexico
      • Albuquerque, New Mexico, United States, 87131
        • Completed
        • University of New Mexico, Health Sciences Center
    • North Carolina
      • Chapel Hill, North Carolina, United States, 27599
        • Completed
        • University of North Carolina Hospital
      • Durham, North Carolina, United States, 27705
        • Recruiting
        • Duke University Maternal and Fetal Medicine
        • Contact:
        • Principal Investigator:
          • Brenna Hughes, MD
        • Contact:
    • Oregon
      • Portland, Oregon, United States, 97239
        • Recruiting
        • Oregon Health & Science University
        • Contact:
        • Principal Investigator:
          • Nicole Marshall
        • Contact:
        • Sub-Investigator:
          • Karen Gibbins
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • Completed
        • Hospital of the University of Pennsylvania Department of Maternal Fetal Medicine
      • Pittsburgh, Pennsylvania, United States, 15213
        • Recruiting
        • University of Pittsburgh School of Medicine
        • Contact:
        • Principal Investigator:
          • Anne-Marie Rick, MD
    • Texas
      • Amarillo, Texas, United States, 79106
        • Not yet recruiting
        • Texas Tech University Health Sciences Center School of Medicine.
        • Contact:
        • Principal Investigator:
          • Kaytlin Krutsch, PharnD
        • Sub-Investigator:
          • Teresa Baker, MD
      • Galveston, Texas, United States, 77555
        • Recruiting
        • University of Texas Medical Branch - Galveston
        • Contact:
        • Contact:
        • Principal Investigator:
          • Gayle Olson, MD
      • Houston, Texas, United States, 77030
        • Recruiting
        • University of Texas Health Science Center at Houston
        • Principal Investigator:
          • Pamela Berens, MD
        • Contact:
      • San Antonio, Texas, United States, 78229
        • Not yet recruiting
        • University of Texas Health Science Center
        • Contact:
        • Principal Investigator:
          • Olaide Balogun, MD
        • Sub-Investigator:
          • Kaashif Ahmad, MD
    • Utah
      • Salt Lake City, Utah, United States, 84132
        • Recruiting
        • University of Utah
        • Principal Investigator:
          • Kathleen Job
        • Sub-Investigator:
          • Lauren Theilen
        • Contact:
    • Washington
      • Seattle, Washington, United States, 98195-7630
        • Completed
        • University of Washington

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Lactating women receiving DOIs per SOC, as prescribed by their healthcare providers, and their breastfed infants.

Description

Inclusion Criteria:

  • Lactating women who are receiving at least one DOI per SOC who are ≤180 days postpartum, and their infants (≤180 days of age) who receive maternal breastmilk.
  • Informed consent/HIPAA obtained, according to local IRB/REB/IEC guidelines, prior to any study-related procedures. Lactating women who are not legal adults and their breastfed infants may be enrolled if they assent to participate in the study and consent is obtained from their legal guardian according to local IRB/REB/IEC guidelines.

Exclusion Criteria:

  • Any concomitant condition which, in the opinion of the physicians providing patient care or the principal investigator conducting the study, would preclude a subject's participation in the study.
  • Known pregnancy during PK sampling.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Other
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Tranexamic acid (TXA)

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
labetalol

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
metformin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
nifedipine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
clindamycin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
oxycodone

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
azithromycin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
escitalopram

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
sertraline

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
ondansetron

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Ciprofloxacin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Doxycycline

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Levofloxacin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Methylphenidate

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Sumatriptan

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Citalopram

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Cyclobenzaprine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Furosemide

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Gabapentin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Hydrochlorothiazide

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Hydroxyurea

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Rosuvastatin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Topiramate

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Trazodone

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Valganciclovir

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Venlafaxine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Verapamil

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Remdesivir

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Anakinra

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Tocilizumab

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Fluvoxamine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Amoxicillin

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Bupropion

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Buprenorphine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Hydrocodone

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Levetiracetam

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Paroxetine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.
Duloxetine

No intervention, observational study and PK collections The study objectives are to characterize the PK and safety profile of DOIs that are commonly administered to lactating women.

The primary focus of this analysis will be to determine drug concentrations in breastmilk and to estimate the relative infant dose.

Understudied drugs will be administered in accordance with local SOC as prescribed by the lactating woman's healthcare provider.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
M/P ratio
Time Frame: Until the infant becomes 180 days of age
Characterize the pharmacokinetics using maternal milk/plasma exposure ratio is calculated by dividing the BMS01 drug of interest breastmilk concentration by the BMS01 drug of interest in maternal plasma concentration.
Until the infant becomes 180 days of age
DID
Time Frame: Until the infant becomes 180 days of age
Pharmacokinetics is characterized by estimated daily infant dose-daily infant dose which estimates the quantity of drug delivered to an infant via breastmilk in a given day.
Until the infant becomes 180 days of age
RID
Time Frame: Until the infant becomes 180 days of age
Pharmacokinetics is characterized by relative infant dose is a method of relating the potential dose of the drug delivered to the infant to the typical therapeutic dose given to the mother.
Until the infant becomes 180 days of age
I/M ratio
Time Frame: Until the infant becomes 180 days of age
Pharmacokinetics is characterized using infant maternal/exposure ratio. IM ratio is calculated using the average infant plasma concentration of the BMS01 drug of interest and historical value of clearance in infants.
Until the infant becomes 180 days of age

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety profile of commonly used drugs in infants exposed to drugs in breastmilk
Time Frame: Until the infant becomes 180 days of age
see Cohort 1-31 for listing of drugs
Until the infant becomes 180 days of age
AE
Time Frame: Up until 180 days of age
Safety profile of commonly used drugs in infants exposed to drugs in breastmilk is characterized by Adverse Events(AE) which are collected at each time point when the study-specific procedure occurred and up until 1 hour after.
Up until 180 days of age
SAE
Time Frame: Up until 180 days of age
Safety profile of commonly used drugs in infants exposed to drugs in breastmilk is characterized by Serious Adverse Events which are directly related to study procedures and were recorded from participants (infant or mother) at each time point when the study-specific procedure occurred and up until 1 hour after.
Up until 180 days of age
ESI
Time Frame: Until the infant becomes 180 days of age
Safety profile of commonly used drugs in infants exposed to drugs in breastmilk is characterized by Events of Special Interest(ESI) which include any pre-specified safety event that could be related to BMS01 drug of interest exposure. ESI's are only assessed for infants and only at study visits from the time the BMS01 DOI was initiated in mother and infant began breast milk feeding through the end of the study / infant age ≤ 180 days
Until the infant becomes 180 days of age

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Principal Investigator: Kanecia Zimmerman, MD, Duke University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 4, 2018

Primary Completion (Estimated)

September 23, 2024

Study Completion (Estimated)

September 23, 2024

Study Registration Dates

First Submitted

April 23, 2018

First Submitted That Met QC Criteria

April 23, 2018

First Posted (Actual)

April 27, 2018

Study Record Updates

Last Update Posted (Estimated)

January 25, 2024

Last Update Submitted That Met QC Criteria

January 24, 2024

Last Verified

January 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Pro00088919
  • HHSN275201000003I/27500051 (Other Grant/Funding Number: NICHD)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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