Disposition of acetaminophen in milk, saliva, and plasma of lactating women

Acetaminophen (APAP) is a widely used analgesic and antipyretic, but its disposition in human milk has not yet been reported. Twelve nursing mothers (nursing two to 22 months) were given a single 650-mg peroral dose of APAP. Simultaneous saliva and milk samples were collected at zero, 1/4, 1/2, 3/4, 1, 2, 3, 5, 8, 12, and 24 hours after maternal dosing. In two mothers plasma samples were also obtained at several points during the first six hours. Single voided urine samples were collected from the infants three to five hours after maternal dosing (two hours after nursing at peak maternal milk levels). All samples were assayed for APAP by high pressure liquid chromatography (HPLC) using a mobile phase of 0.05 M Na acetate pH 4.0-acetonitrile (93:10) with n-butyryl-p-aminophenol as the internal standard. APAP appeared in saliva and milk in the 1/4-hour samples; peak levels (10-15 μg/ml) were achieved by one to two hours. Saliva/mil ratios during the elimination phase ranged from 0.7 to 1.1, with most values between 0.8 and 0.9. In two patients studied, saliva/plasma ratios were 0.9 to 1.0. Elimination phase t 1/2 (calculated from β) ranged from 1.35 to 3.50 (x̄=2.28 ± SD 0.69) hours for milk, and from 1.72 to 3.30 x̄= ± 0.56) hours for saliva. There was close agreement between saliva t 1/2 and milk t 1/2 for each patient. Assuming each infant ingested 90 ml milk at 3, 6, and 9 hours after maternal ingestion of APAP, the amount of APAP available for ingestion ranged from 0.28 to 1.51 mg (x̄= 0.88 ± 0.31) or from 0.04% to 0.23% (x̄=0.14 ± 0.04) of maternal dose. Neither APAP nor metabolite was detected in nursing infants' urine. Maternal APAP ingestion in usual analgesic doses does not appear to present a risk to the nursing infant.