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pediatrician - Dr. Victоr Аbdоw
Rоckville, МD, USА.


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Is it allowed to take I 123 Iodohippurate Sodium during lactation?
Is it safe for a nursing mother and a child?

Radioactive iodine is concentrated in thyroid and breast milk and may suppress thyroid function in infants.The I-123 is used as a diagnostic agent. Its mean physical radioactive lifetime is 13.2 hours and the half-life of biodegradation is 3.5 to 5.8 hours. After 10 physical half-lives, the element ceases to have significant radioactivity and after 5 biological half-lives its concentration in the milk is negligible.If you want to limit exposure to 0 mili Servers (mSv), you should stop breast-feeding for a period equivalent to from 5 to 10 biological half-lives. It is also possible to determine the radioactivity in milk samples.Since the annual natural background radiation we receive is around 6 mSv, for a more conservative approach we should wait just long enough to achieve an infant exposure of less than 1 mSv (0.1 rem) The iodine-123 that is administered to nursing mothers must be pure, that means, without containing traces of I-124 and I-125 Recommended time for transient weaning to ensure reducing exposure to 1 mSv: I-123 as sodium iodine hippurate or orto-iodo hippurate: Doses up to 100 MBq (4 mCi) waiting time= 8 to 12 hours. According to Nuclear Regulatory Commission of the United States: it is not necessary to stop breastfeeding. I-123 as sodium iodide. Doses up to 20 MBq (0.5 mCi) waiting time= 3 to 6 hours. According to Nuclear Regulatory Commission of the United States: it is not necessary to stop breastfeeding. I-123 as iobenguane (I-123 meta-iodobenzylguanidine, I-123-MYBG). Discontinue breastfeeding for 12, 24 or 48 hours depending on whether the dose was 150, 370 or 400 MBq (4, 10 or 11 mCi). I-123 as ioflupane: Stop breastfeeding from 1 to 6 days. If you want to continue breastfeeding, extraction and storage of breast milk in a freezer for days or weeks must be previously ensured. During the suggested days for interruption of breastfeeding after the test is done, the child can be fed exclusively with the milk previously stored or using both breast milk and formula. After the test you can continue extracting and storing the milk in a separated freezer for 10 physical half-lives (132 hours = 5.5 days, once radiation is gone and it can be used for feeding the baby). Mothers receiving a dose as lower as 400 MBq for a thyroid scan are not in need to refrain from close contact with their children.

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Types of risk

VERY LOW RISK
It is allowed while breastfeeding. It is not dangerous for a baby. It is moderately safe. more...

LOW RISK PROBABLE
Possible presence in breast milk is allowed. Follow the doctor's recommendation. more...

HIGH RISK PROBABLE
An unsafe drug, it is necessary to assess the risks while taking. Use safer analogs. more...

VERY HIGH RISK
It is not recommended. You need to stop breastfeeding or choose a safe analog. more...

Scientific literature

The level of risk for breastfeeding is confirmed in these scientific publications:
  1. http://www.ncbi.nlm.nih.gov/pubmed/26732471
  2. https://www.gov.uk/government/publications/arsac-notes-for-guidance
  3. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/492127/ARSAC_NfG_2016.pdf
  4. http://www.ncbi.nlm.nih.gov/pubmed/23979084
  5. http://pediatrics.aappublications.org/content/132/3/e796.full.pdf
  6. http://www.ncbi.nlm.nih.gov/pubmed/20644928
  7. http://www.ncbi.nlm.nih.gov/pubmed/19154964
  8. http://www.bmap.ucla.edu/docs/ICRP_106_RadiationDosetoPatientsfromRadiopharmaceuticals_vol38_2008.pdf
  9. https://scp.nrc.gov/narmtoolbox/nureg1556vol9_rev2_012408.pdf
  10. http://www.ncbi.nlm.nih.gov/pubmed/11013791
  11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2145042/pdf/canfamphys00031-0055.pdf
  12. http://www.ncbi.nlm.nih.gov/pubmed/10809203
  13. http://jnm.snmjournals.org/content/41/5/863.full.pdf
  14. http://www.ncbi.nlm.nih.gov/pubmed/10028630
  15. http://www.ncbi.nlm.nih.gov/pubmed/9467052
  16. http://www.ncbi.nlm.nih.gov/pubmed/7588948
  17. http://www.ncbi.nlm.nih.gov/pubmed/8162943
  18. http://www.ncbi.nlm.nih.gov/pubmed/8162938
  19. http://www.ncbi.nlm.nih.gov/pubmed/7864983
  20. http://www.ncbi.nlm.nih.gov/pubmed/2348243
  21. http://www.ncbi.nlm.nih.gov/pubmed/2271114
  22. http://www.ncbi.nlm.nih.gov/pubmed/2645546
  23. http://www.ncbi.nlm.nih.gov/pubmed/3941360
  24. http://www.ncbi.nlm.nih.gov/pubmed/3018644
  25. http://www.ncbi.nlm.nih.gov/pubmed/3020191
  26. http://www.ncbi.nlm.nih.gov/pubmed/4032049
  27. http://jnm.snmjournals.org/content/26/9/1085.full.pdf
  28. http://www.ncbi.nlm.nih.gov/pubmed/4683207
  29. http://www.ncbi.nlm.nih.gov/pubmed/5168222

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