Assessing whether breastfeeding is safe after an intraoral injection of 68 mg of articaine

Abstract

Background

Limited information is available about the transfer of articaine into breast milk and the associated risks to breastfed infants. As such, health care providers and patients often forgo local anesthesia, postpone dental treatment, or stop breastfeeding after receiving articaine. The authors aimed to evaluate the safety of articaine use in mothers who are breastfeeding by means of examining its pharmacokinetic properties in breast milk and assessing the potential risks to breastfed infants.

Methods

Twelve breastfeeding mothers were randomly assigned to 2 groups and received an injection of 4% articaine (containing 68 mg of articaine) via supraperiosteal infiltration. Group A provided milk samples at various times postadministration, and milk output from group B was measured over the first 3 hours postadministration.

Results

The peak concentration of articaine in breast milk was 256.5 ng/mL at 0.25 hours, and declined to 12.9 ng/mL at 3 hours postadministration. The amount of articaine transferred to breast milk after 3 hours was calculated as 1.12 μg. Pharmacokinetic modeling predicted that the maximum plasma exposure in infants was 0.19 ng/mL, far below toxicity thresholds.

Conclusions

The study findings suggested that breastfeeding mothers can safely resume breastfeeding within 1 through 3 hours after administration of articaine, as the predicted infant exposure was considerably below the concentrations producing a pharmacologic effect.

Practical Implications

The results of this clinical study clarified the safety of using articaine in breastfeeding mothers and the optimal timing for resuming breastfeeding after dental procedures. This clinical trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn). The registration number is ChiCTR2400082053.