| <DIV><FONT size=4>(翻译稿）</FONT></DIV>
<DIV><FONT size=4> ACE抑制剂和血管紧张素II受体拮抗剂不应用于产后几周内的哺乳期母亲，因为可能引起新生儿低血压，特别是对早产儿影响更大。对于年长婴儿的哺乳母亲建议使用卡托普利、恩那普利或者喹那普利。</FONT></DIV>
<DIV><FONT size=4> 血管紧张素转化酶抑制剂和血管紧张素II受体抑制剂适用于任何高血压，特别适用于有糖尿病性肾病变的年轻高血压患者（黑人种群除外）。</FONT></DIV>
<DIV><FONT size=4> 甲基多巴用来怀孕妇女和哺乳期妇女的高血压治疗，但它对某些妇女并不适合。</FONT></DIV>
<DIV><FONT size=4> 孕妇的使用：提醒</FONT></DIV>
<DIV><FONT size=4> 血管紧张素II是正常肾组织分泌的，使用ACE抑制剂和血管紧张素II受体拮抗剂能够引起肾的不良影响和先天畸形。一些数据显示妊娠前三个月使用ACE抑制剂和血管紧张素II受体拮抗剂能够增加先天畸形的风险，因此，ACE抑制剂和血管紧张素II受体拮抗剂禁用于妊娠的各个阶段，除非在权衡利弊的基础上不得不使用。</FONT></DIV>
<DIV><FONT size=4> 哺乳期的使用：</FONT></DIV>
<DIV><FONT size=4> ACE抑制剂</FONT></DIV>
<DIV><FONT size=4> 一般而言，ACE抑制剂都是分子结构比较小的药物，容易分泌到乳汁中。而卡托普利除外，ACE抑制剂的活性代谢物有长的半衰期；然而，这些代谢物很少被口服吸收。数据显示，卡托普利、恩那普利和喹那普利在乳汁中的含量很少。资料表明，ACE抑制剂能够分泌到乳汁中。虽然通过母乳喂养到达婴儿的ACE抑制剂不足以引起临床症状，但也没有足够的证据证明不会产生新生儿低血压，特别是早产儿。</FONT></DIV>
<DIV><FONT size=4> 血管紧张素II受体拮抗剂</FONT></DIV>
<DIV><FONT size=4> 没有资料证明血管紧张素II受体拮抗剂是可以使用的。这些药物分子小，容易分泌到乳汁，一些未出版的研究证明哺乳老鼠乳汁中含有该类药物。然而，大多数血管紧张素II受体拮抗剂具有高的血浆蛋白结合率，这也限制了药物向乳汁中分泌。对于婴儿的影响还未可知。</FONT></DIV>
<DIV><FONT size=4> 用药建议：</FONT></DIV>
<DIV><FONT size=4> ACE抑制剂:</FONT></DIV>
<DIV><FONT size=4> 卡托普利、恩那普利、喹那普利：不建议用于产后几周内哺乳母亲，因为可能产生新生儿低血压，特别是早产儿。可以考虑应用于婴儿比较的的哺乳母亲，但建议对婴儿可能出现的低血压症状进行随访。</FONT></DIV>
<DIV><FONT size=4> 雷米普利、赖诺普利、福辛普利、群多普利、莫西普利、培多普利：不建议应用于哺乳期妇女。应该建立更好的抗高血压治疗措施，特别是有新生儿和早产儿的妇女。</FONT></DIV>
<DIV><FONT size=4> 血管紧张素II受体拮抗剂:</FONT></DIV>
<DIV><FONT size=4> 不建议用于哺乳期妇女，应该建立更好的抗高血压治疗措施，特别是有新生儿和早产儿的妇女。</FONT></DIV>
<DIV align=left><B></B> </DIV>
<DIV align=left><B>原文</B></DIV>
<DIV align=left><B>ACE inhibitors and angiotensin II receptor antagonists:recommendations on use during breastfeeding</B></DIV>
<DIV align=left>ACE inhibitors and angiotensin II receptor antagonists should not be used by breastfeeding</DIV>
<DIV align=left>mothers in the first few weeks after delivery because of possible profound neonatal</DIV>
<DIV align=left>hypotension; preterm babies may be at particular risk. In mothers who are breastfeeding older</DIV>
<DIV align=left>infants, the use of captopril, enalapril, or quinapril may be considered</DIV>
<DIV align=left>Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists</DIV>
<DIV align=left>are licensed for a range of conditions including hypertension and may be particularly</DIV>
<DIV align=left>suitable for young patients with high blood pressure (but not those of black ethnic origin)</DIV>
<DIV align=left>and those with some comorbidities such as diabetic nephropathy.</DIV>
<DIV align=left>Methyldopa is recognised to be the antihypertensive of choice during pregnancy and</DIV>
<DIV align=left>breastfeeding, but will not be suitable for some women and other options may need to</DIV>
<DIV align=left>be explored.</DIV>
<DIV align=left><B>Use in pregnancy: reminder</B></DIV>
<DIV align=left>Angiotensin II is essential for normal kidney development, and the use of ACE inhibitors</DIV>
<DIV align=left>and angiotensin II receptor antagonists in late pregnancy has been associated with</DIV>
<DIV align=left>adverse effects on the kidney and other congenital anomalies. Some data have also</DIV>
<DIV align=left>suggested an increased risk of congenital anomaly after exposure during the first</DIV>
<DIV align=left>trimester of pregnancy.1 Therefore, ACE inhibitors and angiotensin II receptor antagonists</DIV>
<DIV align=left>should not be used at any stage of pregnancy unless absolutely necessary, and only</DIV>
<DIV align=left>then after the potential risks and benefits have been discussed with the patient.</DIV>
<DIV align=left><B>Use during breastfeeding</B></DIV>
<DIV align=left><I>ACE inhibitors</I></DIV>
<DIV align=left>In general, ACE inhibitors have a small molecular size and so their transfer to breast milk</DIV>
<DIV align=left>is possible. With the exception of captopril, the active metabolites of ACE inhibitors have</DIV>
<DIV align=left>long elimination half-lives; however, these metabolites are poorly absorbed orally. Data</DIV>
<DIV align=left>on the use of ACE inhibitors in breastfeeding are sparse and relate mostly to captopril,</DIV>
<DIV align=left>enalapril, and quinapril; findings indicate that drug is transferred to breast milk.2–4</DIV>
<DIV align=left>Although the levels transferred to an infant via breastfeeding are unlikely to be clinically</DIV>
<DIV align=left>relevant, there are insufficient data to exclude a possible risk of profound neonatal</DIV>
<DIV align=left>hypotension, particularly in preterm babies.</DIV>
<DIV align=left><I>Angiotensin II receptor antagonists</I></DIV>
<DIV align=left>No data on the use of angiotensin II receptor antagonists are available. These agents are</DIV>
<DIV align=left>also small enough to pass into breast milk, and some unpublished studies have found</DIV>
<DIV align=left>them in the milk of lactating rats. However, most angiotensin II receptor antagonists are</DIV>
<DIV align=left>highly bound to maternal plasma proteins, which can substantially limit their transfer into</DIV>
<DIV align=left>breast milk. The effects of potential exposure on a nursing infant are unknown.</DIV>
<DIV align=left><B>Advice for healthcare professionals:</B></DIV>
<DIV align=left><I>ACE inhibitors:</I></DIV>
<DIV align=left>? Captopril, enalapril, or quinapril: use in breastfeeding is not recommended in</DIV>
<DIV align=left>the first few weeks after delivery because of the possibility of profound neonatal</DIV>
<DIV align=left>hypotension; preterm babies may be at particular risk. Use may be considered</DIV>
<DIV align=left>when the infant is older if an ACE inhibitor is necessary for the mother; careful</DIV>
<DIV align=left>follow-up of the infant for possible signs of hypotension is recommended</DIV>
<DIV align=left>? Ramipril, lisinopril, fosinopril, trandolapril, moexipril, or perindopril: use in</DIV>
<DIV align=left>breastfeeding is not recommended. Alternative treatments with more established</DIV>
<DIV align=left>safety profiles during breastfeeding are preferable, especially while nursing a</DIV>
<DIV align=left>newborn or preterm baby</DIV>
<DIV align=left><I>All angiotensin II receptor antagonists:</I></DIV>
<DIV align=left>? Use in breastfeeding mothers is not recommended. Alternative antihypertensive</DIV>
<DIV align=left>treatments with more established safety profiles during breastfeeding are</DIV>
<DIV align=left>preferable, especially while nursing a newborn or preterm baby</DIV>
<DIV> </DIV> |
