Binding of drugs in milk : the role of casein in milk protein binding

Unbound fractions of 14C-labeled diazepam and tenoxicam in skimmed milk of various species (man, horse, goat, cow, sheep, dog, rabbit) with different milk compositions were determined. Furthermore, the protein binding of five 14C-labeled benzodiazepines differing in their lipophilicity (bromazepam, clonazepam, diazepam, flumazenil, and flunitrazepam) were measured in human milk and in artificially prepared solutions of individual milk proteins (lactoferrin, 2.4 g/liter; alpha-lactalbumin, 2.1 g/liter; albumin, 0.4 g/liter; and casein--2.1, 3.4, and 13.3 g/liter). The extent of binding was determined by equilibrium dialysis of protein solution against 1/15 M phosphate buffer, made isocryoscopic with lactose. The results showed that the casein fraction is a major binding component in milk for all tested drugs. The extent of binding of diazepam and tenoxicam in the milk of various species was independent of the whey protein concentration. In human milk the fraction of bromazepam, clonazepam, diazepam, and flunitrazepam bound to casein was higher than that bound to any other of the milk proteins tested. Albumin contributed little to the overall binding of these benzodiazepines, and lactoferrin and alpha-lactalbumin did not account for significant binding. The benzodiazepine antagonist flumazenil showed the lowest overall binding in milk and in casein solution. As the casein concentration is highest in colostral milk and drops during the course of lactation, it is expected that M/P ratios of drugs strongly bound to casein are higher during the first days postpartum than in later phases of lactation.