Totem when breastfeeding. Is it possible or not, reviews

Most often, women after childbirth are diagnosed with iron deficiency anemia (IDA). This is explained by the fact that during labor, expectant mothers lose at least 200–300 ml of blood, then blood loss continues in the form of postpartum discharge for 7–10 days. Anemia is manifested by weakness, decreased performance, drowsiness, headaches, fainting, etc. This condition negatively affects the condition of hair and nails.

Totema is a complex remedy based on iron, copper, manganese, which has an antianemic effect. The drug is used for the prevention and treatment of iron deficiency conditions. Women are wondering whether a nursing mother can take Totem. Doctors say that the medicine is safe if the dosage and instructions for use are followed.

Composition and release form

The drug under discussion is a combined modern remedy against anemia. It helps get rid of the deficiency of 3 important minerals in the body at once.

The remedy allows you to cope with the problem in a short time. This is possible thanks to the composition of the drug.

The table will help you understand it in detail:

Only the first 3 substances are the main ones in the drug. The rest are auxiliary components. For example, to improve the taste and consistency of the product.

Totem during breastfeeding

The drug is available in the form of an oral solution. If you open one glass ampoule, you can see a transparent liquid of a dark brown hue. It has a bright odor, characteristic of preparations with a large portion of iron in the composition.

Totema solution for oral administration in ampoules 10ml No. 20

Name

Totema amp. 10ml No. 20

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 25°C.

Expiration date from date of manufacture

2 years

Product description

The solution for oral administration is dark brown in color, with a characteristic odor; There may be some slight sediment.

pharmachologic effect

Combined antianemic drug. Contains iron, which is necessary for the synthesis of heme, which is part of hemoglobin, myoglobin, flavoproteins, iron-ferritin and iron-transferrin complexes, various enzymes; participates in a number of redox reactions. Copper and manganese are microelements and are cofactors for some enzymes. The absorption of microelements is more intense, the greater the iron deficiency in the body. When taking the drug, there is a gradual regression of clinical and laboratory symptoms of anemia.

Pharmacokinetics

Pharmacokinetics Absorption of iron and other trace elements occurs predominantly in the duodenum and upper jejunum.

Indications for use

Treatment and prevention of iron deficiency anemia in adults and children from 3 months of age caused by various reasons:

• bleeding;
• increased need for iron (pregnancy);
• insufficient intake of iron from food or impaired absorption.

Use during pregnancy and lactation

The drug is allowed to be used during pregnancy and lactation according to indications in recommended doses.

special instructions

Monitoring the effectiveness of treatment should be carried out no earlier than 3 months after the start of treatment. Excessive tea consumption inhibits iron absorption. To avoid darkening of tooth enamel, prolonged exposure of the drug solution to the oral cavity should be avoided. Patients with diabetes should take into account that 10 ml of the drug contains 3 g of sucrose. 1 ampoule of the drug contains 1/4 XE, the maximum daily dose (in 4 ampoules of the drug) is 1 XE. During treatment with iron supplements, patients may experience black stool, however, this does not require medical intervention. During treatment with iron supplements, a stool occult blood test may give a false-positive result. Effect on the ability to drive vehicles and operate machinery There is no data on the negative effect of the drug on the ability to drive vehicles and other mechanisms.

With caution (Precautions)

The drug should be prescribed with caution for diabetes mellitus.

Contraindications

• anemia not associated with iron deficiency;
• hemochromatosis, hemosiderosis;
• thalassemia;
• peptic ulcer of the stomach and duodenum in the acute phase;
• lead intoxication;
• copper or manganese intoxication, Wilson-Konovalov disease;
• sucrase/isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption syndrome;
• children up to 3 months;
• hypersensitivity to the components of the drug.

Directions for use and doses

To treat anemia, adults are prescribed the drug at the rate of 100-200 mg of iron (2-4 amp.)/day; children over 3 months old - at the rate of 5-7 mg/kg body weight/day in 2-4 doses. The use of the drug is carried out under the control of the iron content in the blood serum, the total iron-binding capacity of the serum before the start of treatment and subsequently at intervals of 1 time in 2 months. For preventive purposes, adults and pregnant women (starting from the 4th month of pregnancy) are prescribed 50 mg (1 amp.)/day. For children, depending on age, the drug is prescribed in a dose ranging from 1/4 to 1/2 the daily therapeutic dose of adults. The duration of treatment is determined individually. The average duration of taking the drug is from 3 to 6 months (until the iron reserves in the body are restored). Instructions for using the drug: Shake well before use. You should tear off a piece of cardboard from the pack along the dotted line and bend it in half to safely break the tip of the ampoule. Break the ampoule on both sides, pour the contents of the ampoule into a glass, dissolve in plain or sweetened water. Take orally, before meals.

Overdose

Symptoms: weakness, hyperthermia, convulsions, nausea, vomiting, constipation, diarrhea, epigastric pain. Cases of necrosis of the walls of the gastrointestinal tract and shock have been described. Treatment: gastric lavage with 1% sodium bicarbonate solution (baking soda). When the concentration of iron in the blood serum is more than 5 mcg/ml, deferoxamine is administered intravenously slowly: for children - 15 mg/kg/h, for adults - 5 mg/kg/h (up to 80 mg/kg/day); for mild poisoning IM: children - 1 g every 4-6 hours, adults - 50 mg/kg (up to 4 g/day); carry out symptomatic therapy; If shock occurs, antishock therapy is carried out.

Side effect

From the digestive system: staining of stool black (this is normal), heartburn, nausea, vomiting, diarrhea, constipation, pain in the epigastric region, darkening of tooth enamel. Other: allergic reactions.

Compound

1 amp. iron (elemental, in the form of iron gluconate dihydrate) 50 mg manganese (elemental, in the form of manganese gluconate) 1.33 mg copper (elemental, in the form of copper gluconate) 700 mcg Excipients: glycerol - 2.52 g, dextrose (glucose) - 80 mg, sucrose - 3 g, anhydrous citric acid - 27.4 mg, sodium citrate dihydrate - 30 mg, sodium benzoate - 20 mg, polysorbate 80 - 24 mg, caramel color TPS (E150c) - 50 mg, tutti-frutti flavoring - 20 µl , purified water - up to 10 ml.

Interaction with other drugs

The simultaneous use of the drug Totema® leads to a decrease in the absorption of bisphosphonates, ciprofloxacin, and tetracyclines when taken orally. Salts, oxides and hydroxides of magnesium, aluminum and calcium interfere with the absorption of iron salts. Totema® should be taken no earlier than 2 hours after taking these medications. You cannot combine the drug with other iron preparations, incl. administered parenterally.

Release form

The solution for oral administration is dark brown in color, with a characteristic odor; There may be some slight sediment. 1 ml 1 amp. iron (elemental, in the form of iron gluconate dihydrate) 5 mg 50 mg manganese (elemental, in the form of manganese gluconate) 133 mcg 1.33 mg copper (elemental, in the form of copper gluconate) 70 mcg 700 mcg Excipients: glycerol - 2.52 g, dextrose ( glucose) - 80 mg, sucrose - 3 g, anhydrous citric acid - 27.4 mg, sodium citrate dihydrate - 30 mg, sodium benzoate - 20 mg, polysorbate 80 - 24 mg, caramel color TPS (E150c) - 50 mg, tutti flavoring -frutti" - 20 µl, purified water - up to 10 ml. 10 ml - double-ended ampoules made of yellow glass type III (10) - cardboard trays (2) - cardboard packs.

Terms of sale, prices

Totem during breastfeeding can only be prescribed by a doctor. Women are not recommended to make their own decisions about the need to take a drug to eliminate anemia. Uncontrolled use of the solution can lead to negative consequences. For this reason, today you can purchase the drug in a pharmacy only with a doctor’s prescription.

The product is sold in most specialized retail outlets throughout Russia. You can also order it from an online pharmacy, but in this case the prescription will have to be presented to the courier upon receipt of the goods.

The totem is packaged in a small, thick cardboard box of white and red color. Inside there is a substrate with transparent glass ampoules. They resemble an injection drug. In this case, the drug is taken orally.

The standard package contains 10 glass ampoules. Each of them contains 10 ml of the drug. To take the solution, you will need to carefully break off the glass tip of one ampoule. Afterwards, its contents are poured into a glass or other suitable container.

The cost of the product depends on the region in which it is purchased and on each specific retail outlet. On average, its price ranges from 300 to 700 rubles. per package with 10 ampoules of 10 ml of solution.

Pharmacological properties

Totema belongs to the combined iron preparations. It combines the main active ingredient with 2 additional ones. The use of such a remedy allows the patient to compensate for several important deficiencies in the body at once. Most often it is prescribed for anemia.

Iron from the drug is necessary for many important reactions in the body and its normal functioning in general. For example, for heme synthesis. Copper and manganese are combined with it, since these components contain enzymes that improve the process of iron absorption.

Description of the dosage form

The drug is available in the form of an oral solution, which contains the following substances:

• iron;
• manganese;
• copper;
• glycerol;
• glucose;
• sugar;
• food additive E330;
• sodium salt of citric acid;
• additive E211;
• twin-80;
• water;
• food coloring;
• aromatic additive.

The dark brown solution has a specific aroma and a slight sediment.

The drug has an antianemic effect and compensates for the lack of iron in the body. After regular use, hemoglobin concentration increases. Copper and manganese enhance the absorption of iron in the jejunum and duodenum. The higher the microelement deficiency, the more iron is absorbed from the drug.

Totem is used to prevent or treat iron deficiency anemia in patients from 3 months of age and adults. IDA develops after heavy or regular bleeding, during pregnancy or after childbirth, with insufficient intake of the mineral from food or impaired absorption.

Pharmacodynamics and pharmacokinetics

When the solution is taken orally, no more than 20% of a single dose is absorbed in the stomach and intestines. Soon after this, the drug begins to act and replenish iron reserves in the body.

Iron begins to be absorbed first in the duodenum, as well as in the upper part of the jejunum. One part of the substance immediately enters the blood. And the other one lingers on the intestinal mucosa. She is deposited there and waits her turn. As required in the future, the substance again enters the plasma.

If you take the drug continuously in the course prescribed by your doctor, then all the symptoms of anemia gradually go away. The patient's well-being improves markedly.

Features of interaction and manufacturer's instructions

The abstract points out the following nuances:

• Totema is not combined with drugs for parenteral administration that contain iron;
• combination with iron-containing medications can lead to fainting and shock;
• It is necessary to observe an interval of 120 minutes between taking the drug and tetracyclines, fluoroquinolones, thyroxine, penicillamine;
• If you drink too much, the rate of iron absorption slows down sharply.

When treating with Totema, you must adhere to the following instructions:

• the medication is not suitable for solving the problem of reduced levels of iron in the blood serum that occur with inflammatory pathologies;
• treatment of vitamin deficiency should be carried out together with the elimination of the sources that provoked it;
• When using the solution, it must be swallowed immediately to avoid darkening of the enamel.

Patients with diabetes mellitus should not forget that 50 ml of the product contains sucrose (3 g) with glucose (0.08 g) and a quarter of XE. Each ampoule of solution contains a small amount of ethanol.

The drug does not affect the reaction rate. During the procedures, patients can drive vehicles and work with complex moving mechanisms.

Indications for use in hepatitis B

Totema during breastfeeding is prescribed to women who have been diagnosed with a lack of iron in the body. The drug is used to treat anemia. Often - as the main and only means.

Sometimes the solution is chosen as a prophylactic agent to prevent possible negative consequences from a lack of iron in the body. This is especially true if a woman’s balance of important substances is disrupted after childbirth. This often happens with a large loss of blood, after a cesarean section.

If a woman had an iron deficiency during pregnancy, then after childbirth its level must be measured again. If the problem is not solved, the young mother is recommended to continue taking anti-anemia medications during lactation. Often it is Totema who is appointed, which allows you to quickly and cost-effectively correct the situation.

If a woman’s iron deficiency is just discovered and it is not critical, then the doctor may suggest waiting until after feeding. It is important that the woman does not have any obvious symptoms of a lack of this substance and does not feel worse.

How does it affect the child?

Totem during breastfeeding is increasingly prescribed to young mothers by modern doctors. But to date, no large-scale studies have been conducted on the effect of the drug on the newborn. There is even no general data on the penetration of the drug into breast milk. For this reason, doctors advise not to take risks and if any doubts arise about the use of the drug by a nursing mother - to abstain from this or simply postpone therapy until the end of the lactation period.

Interestingly, the drug can also be prescribed to newborns. It is approved for use by children from 3 months of age. In this case, the optimal dosage is calculated based on the baby’s weight. For every 1 kg of body weight, it is optimal to prescribe 3 mg of the drug. For newborns to take Totema, it is quite difficult to divide the solution into the required portions.

To do this you should:

1. Break the ampoule with the drug at both ends and pour the contents into a glass.
2. Make sure that no glass chips or other unnecessary particles get into the solution.
3. Pour the product into a measuring spoon or syringe.
4. Calculate the required portion, taking into account the child’s weight.
5. Dissolve the drug in any liquid. For a newborn, this is usually purified water. But it is not recommended to dissolve Totem in milk. This option is allowed only in extreme cases. For example, when the child does not drink any other liquids.

After the first use, it is recommended to closely monitor the child’s condition. An allergic reaction is possible.

The solution is prescribed to a newborn in 2 cases:

• if the baby himself is diagnosed with iron deficiency anemia by an appropriate blood test;
• if the problem is detected in the mother during the last stages of admission.

Possible complications for the fetus

When breastfeeding, Totem should be taken with extreme caution. Despite the fact that there is no data confirming the negative effects of the drug on newborns, you need to be wary of the following possible consequences:

• poisoning of a child with manganese or copper;
• overdose of iron in the body;
• exacerbation of congenital diseases of the stomach or intestines;
• unstable state of the nervous system - anxiety, poor sleep.

If a nursing mother takes a drug containing iron, then for the first few days she should especially carefully monitor the condition and well-being of the newborn. It is advisable to carefully inspect it during hygiene procedures. If allergic reactions to the drug occur on the child’s skin, redness and rashes may be noticed. They often manifest themselves with severe itching.

There is also the possibility of despotic disorders. Among them: pain and discomfort in the stomach, heaviness, painful or difficult digestion. In a newborn, such consequences can be expressed by strong constant uncontrollable crying, problems with sleep, refusal to eat, regurgitation of milk and water.

If such manifestations are noticed, the woman should stop taking the drug as soon as possible and consult a doctor. The specialist will adjust the prescribed therapy and select more suitable means or even postpone treatment for a while.

If a nursing mother uses Totem in large dosages, this can quickly lead to an excess of iron salts in the child. In this case, the drug should be stopped immediately. A newborn may even require medical attention. It consists of gastric lavage.

Contraindications

Totema during breastfeeding is often prescribed to women with a lack of iron in the body.

But there are situations in which the drug will have to be abandoned even if this problem exists:

• with exacerbation of duodenal or gastric ulcer;
• with anemia of a different nature (not related to iron levels);
• for serious problems with hematopoiesis.

It is also contraindicated to take the solution if a woman is hypersensitive to any components of its composition. It is strictly prohibited to combine it with other iron supplements. This does not even depend on the method of their entry into the body. You cannot combine, for example, an injection and taking the solution orally.

If a woman is already taking any vitamin complexes, then before adding Totems to them, it is worth carefully studying the composition of the first ones. If they contain iron, you will have to choose only one option.

Contraindications and restrictions

Totema should not be taken for the following diseases and conditions:

• Intolerance to the components of the medication.
• Anemia that is not associated with iron deficiency.
• Pigmentary cirrhosis, hemosiderosis.
• Cooley's anemia.
• Gastric and duodenal ulcers with acute course.
• Lead poisoning.
• Poisoning with copper, manganese, hepatocerebral dystrophy.
• Sucrose-isomaltose or glucose-galactose deficiency, fructosemia.

In addition, the medicine is contraindicated in children under 3 months. Under the supervision of a doctor, the medication is taken by diabetics, as it contains sucrose.

If the rules of administration are violated or there is a contraindication, negative reactions occur:

• darkening of tooth enamel;
• skin rash, itching;
• black stool;
• burning behind the sternum, nausea, vomiting, defecation disorders (diarrhea, constipation).

If adverse reactions occur, you should stop taking the medication and consult a doctor. During treatment with Totem solution, it is not recommended to drink tea or milk. To avoid such an unpleasant symptom as darkening of teeth, you need to drink the solution through a straw. Dark feces after taking the medicine are normal.

When using an excessive dose or independently prolonging the course of treatment, the likelihood of gastralgia, nausea, frequent and loose stools increases. To eliminate these symptoms, the stomach is washed with soda solution (1%). When iron levels rise to 5 mg/ml, the patient is given Deferoxamine.

Totema reduces the absorption of bisphosphonates, ciprofloxacin, and tetracyclines when administered orally. It is not recommended to combine an antianemic agent with salts, oxides, magnesium hydroxide, aluminum, and calcium. This combination leads to less absorption of iron. Totema is taken 120 minutes after consuming the previously described medications. Totema is prohibited from being combined with iron-containing medications that are administered parenterally (bypassing the digestive tract).

Directions for use and doses

According to the instructions, the drug in question must be used before meals. First, the glass ampoule is broken on both sides, after which its contents are poured into a glass and mixed with any liquid. Slightly sweetened drinking water is perfect for this. Shake the product well before use. It is recommended to drink Totem already diluted in water as soon as possible. It is prohibited to store it longer than 25 hours in this form.

A newborn can only use the drug from 3 months. The dosage is calculated according to the scheme 3 mg per 1 kg of weight. From 1 year to 5 years, a child can take 50 mg of the drug per day.

From 5 to 12 years old, 1-2 ampoules of the drug are allowed daily. And patients after 12 years can drink up to 100 mg per day.

In this case, the dosage of the drug for the patient depends not only on his age, but also on the severity of anemia. If this is the average form, then an adult is prescribed 3 ampoules of the solution per day. If severe - up to 200 mg per day. For children, the optimal dosage is calculated by the attending physician.

For pregnant and nursing mothers, this dosage also changes. In the first case, with a mild degree of anemia, the girl is recommended to drink 2 ampoules per day, with moderate anemia - up to 150 mg, with severe anemia - up to 200 mg. And in the second, regardless of the severity of the problem - 1 ampoule per day.

The dosage chosen for the patient can be consumed in different ways. The first option is 2-3 doses before meals throughout the day. The second option is immediately, for example, before breakfast or before lunch.

How long to take the drug is decided on a case-by-case basis. To do this, the patient must undergo regular blood tests. For example, nursing mothers are advised to take the medicine until the hemoglobin level returns to normal. On average, treatment usually takes 4-6 months. If the drug is prescribed for preventive purposes, then it must be taken for 1-2 months.

A young mother during lactation should evaluate her condition before starting to take Totem. Especially if the newborn is still younger than 1 month. If possible, taking the drug should be postponed for at least 30-50 days after birth. During this period, a woman can try to adjust the level of iron in the body through nutrition.

Application of medicine

The solution is consumed orally, after mixing with filtered or sweetened water. The medicine is taken before eating.

Daily dosage of medication for the treatment of IDA in patients of different age categories:

• from 3 months to 16 years – from 5 to 7 mg/kg of total body weight twice or four times;
• from 18 years – 2 – 4 ampoules.

Before using the drug, the iron-binding capacity of the blood serum is assessed, then this value is checked once every 4 weeks. In addition, serum iron concentrations should be monitored during treatment.

To prevent IDA, adults and expectant mothers from the 13th week of pregnancy take 1 ampoule of solution per 24 hours. The dose of medicine for children depends on the patient’s age and symptoms; it is approximately ¼ – ½ of the daily dose.

The doctor determines the duration of the therapeutic course individually for each patient. Typically, the medicine is taken for 12 to 24 weeks until the body's iron stores are restored. Before administration, the solution is shaken to ensure uniform distribution of particles.

Analogues for hepatitis B

Any iron supplements should be taken with caution during lactation. This also applies to all modern analogues of Totem. Most often, this drug for nursing mothers is replaced with Actiferrin drops or Ferretab capsules. Both of them can be prescribed exclusively by a doctor and if the potential benefit to the mother outweighs the possible harm to the child.

Totema is not prohibited during breastfeeding. But its effect on the newborn and penetration into mother’s milk has not yet been fully studied and proven. Therefore, young mothers should use the drug with caution.