A literature review of drug transport mechanisms during lactation

The literature review titled “A literature review of drug transport mechanisms during lactation,” authored by Christine Gong, Lynn N. Bertagnolli, David W. Boulton, and Paola Coppola, consolidates current knowledge on how drugs are transported to breast milk. It addresses concerns that lactating mothers may discontinue breastfeeding due to fears of infant drug exposure. The review identifies four primary mechanisms of drug transport from maternal plasma to breast milk: passive transport, active transport, lipid co-transport, and transcytosis. It also summarizes the expression changes of 20 drug transporters during lactation, noting that 9 are downregulated while 11 are upregulated. Understanding these mechanisms is crucial for estimating infant drug exposure, developing physiologically based pharmacokinetic (PBPK) models, and guiding clinical drug development for lactating populations.