In the well-established realm of perioperative care, drugs such as ondansetron and dexamethasone hold standard positions. Their widespread acceptance stems from their non-sedating properties, and despite limited exhaustive research, they are largely regarded as safe, as indicated by the absence of reported adverse effects in infants.
Given the limited data on the use of systemic dexamethasone during breastfeeding, it may be prudent to opt for an alternative corticosteroid. Local injections, such as those administered for tendinitis, are unlikely to elicit adverse effects in breastfed infants. It's worth noting that medium to large doses of corticosteroids, including dexamethasone, administered systemically have been associated with temporary lactation suppression.
Metoclopramide stands out due to its acknowledged safety profile and its dual functionality as a galactagogue, stimulating serum prolactin levels. While its non-sedating attributes reinforce its safety, a few studies suggest a minor transfer (less than 10%) of the maternal dose to infants. Nevertheless, the clinical significance of such transfers warrants further investigation.
For those exploring newer agents like aprepitant, it's crucial to recognize the prevailing limitations in our understanding and assertions regarding these medications. Their role and safety remain subjects of ongoing investigation.
