GHB Levels in Breast Milk of Women with Narcolepsy with Cataplexy Treated with Sodium Oxybate

Abstract Objective To determine GHB levels in breastmilk of women taking sodium oxybate (Xyrem) for treatment of narcolepsy and cataplexy. Methods Two women with narcolepsy and cataplexy treated with sodium oxybate before pregnancy collected breast milk for analysis of GHB concentration after resumi...

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Bibliographic Details
Published in:Sleep medicine 2017-08, Vol.36, p.172-177
Main Authors: Barker, Emily C., Ph.D, Puchowicz, Michelle, Ph.D, Letterio, John, M.D, Higgins, Kristine, Sharkey, Katherine M., M.D., Ph.D
Format: Article
Language:English
Subjects:
Adult
Breastfeeding
Female
Gas Chromatography-Mass Spectrometry
GHB
Humans
Milk, Human - chemistry
Milk, Human - drug effects
Narcolepsy
Narcolepsy - drug therapy
Narcolepsy - metabolism
Neurology
Postpartum
Sleep
Sleep Medicine
Sodium oxybate
Sodium Oxybate - pharmacokinetics
Sodium Oxybate - therapeutic use
Time Factors
Wakefulness-Promoting Agents - pharmacokinetics
Wakefulness-Promoting Agents - therapeutic use
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Summary:Abstract Objective To determine GHB levels in breastmilk of women taking sodium oxybate (Xyrem) for treatment of narcolepsy and cataplexy. Methods Two women with narcolepsy and cataplexy treated with sodium oxybate before pregnancy collected breast milk for analysis of GHB concentration after resuming sodium oxybate postpartum. One woman collected samples across two consecutive nights (doses: 3.0gm and 4.5gm twice per night) five months after delivering her first child; the other collected samples on three separate days (doses: 2.25gm and 3.0gm twice per night) nine months after the births of her first two children. GHB concentration was determined by gas chromatography/mass spectrometry. Results Milk GHB levels before sodium oxybate ranged from 5.81-7.60 ìM. Levels were two-to four times higher four hours after the first sodium oxybate dose (10.44-23.58 ìM) and three-to -five times higher four hours after the second dose (ie, eight hours after first dose; 14.60-34.01 ìM). GHB levels returned to endogenous levels 6-10 hours following the second dose, however variability was observed between patients and pregnancies. Higher breast milk GHB levels were observed with higher doses for both patients. Conclusions Sodium oxybate is transmitted to breast milk. Despite its short half-life, GHB concentrations remained two-to-five times higher than endogenous levels four hours after both nighttime doses. To avoid excess GHB exposure, breastfeeding mothers who take sodium oxybate should consider expressing and discarding their morning milk. Future work should examine milk GHB levels after chronic sodium oxybate and determine whether levels change as milk composition changes across the postpartum period.
ISSN:1389-9457
1878-5506
DOI:10.1016/j.sleep.2017.05.008