Stillen unter Methadon- bzw. Buprenorphin-Substitutionstherapie

Zusammenfassung

Hintergrund:

Die Zahl Opioidabhängiger, welche sich in Substitutionstherapie befinden, steigt kontinuierlich an. In Deutschland ist Methadon mit 57,7% das am häufigsten verordnete Substitutivum gefolgt von Buprenorphin mit 18,6%. Besonders schwangere Frauen und die ungeborenen Kinder profitieren von einer adäquaten Substitutionstherapie. Verunsicherung besteht jedoch für die Stillempfehlungen unter Substitutionstherapie, da sowohl Methadon als auch Buprenorphin in der Muttermilch angereichert werden und somit Sorge um Gesundheitsschäden des Neonaten nicht unbegründet sind. Stillvorteile müssen gegen mögliche neonatale Schädigungen abgewogen werden.

Methode:

Diese Übersicht basiert auf einer selektiven Literaturaufarbeitung unter Einbeziehung der PubMed-Datenbank und deutschsprachiger Konsensustexte. Verwendetete Suchbegriffe: (methadone*) AND (breastfeeding OR lactation), (methadone*) AND (human milk), (buprenorphine*) AND (breastfeeding OR lactation) und (buprenorphine*) AND (human milk).

Schlussfolgerung:

Nach Durchsicht der verfügbaren Literatur rechtfertigt die reine Substitutionstherapie mit Methadon oder Buprenorphin das primäre Abstillen nicht. Der Stillvorteil überwiegt die Risiken einer vital bedrohlichen neonatalen Substanzingestion, so dass Stillen unter beiden Substanzen möglich ist.

Abstract

Background:

The number of opiate addicted patients treated with opioid replacement therapy is continuously increasing. In Germany, 57.7% of these patients are treated with methadone and 18.6% with buprenorphine. This maintenance therapy provides several advantages while addicted pregnant women and their foetus have a high benefit from appropriate replacement therapy. However, the recommendations concerning breast feeding during an opioid replacement therapy are discussed controversially, because methadone as well as buprenorphine accumulate in breast milk. This accumulation might cause damages to the newborn’s health; so, child benefits of breast feeding have to be balanced with possible health risks.

Methods:

This review provides an overview of a selective literature search based on the PubMed-database and german consensus recommendations. Used search terms included: (methadone*) AND (breastfeeding OR lactation), (methadone*) AND (human milk), (buprenorphine*) AND (breastfeeding OR lactation) and (buprenorphine*) AND (human milk).

Results:

According to the available literature, addicted women, substinated with methadone or buprenorphine are allowed to breast feed their newborns. The advantages of breast feeding prevail the risks of an infant opiate intoxication caused by methadone or buprenorphine.

Schlüsselwörter

Stillen - Schwangerschaft - Drogenkonsum - Methadon - Buprenorphin

Key words

breast feeding - pregnancy - drug addiction - methadone - buprenorphine

• Literatur

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