Table 4 |
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|
Immunosuppressive, cytotoxic and biological drugs during lactation |
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| Drug |
Secretion into breast milk |
Effect on nursing infant |
Breastfeeding allowed |
|
|
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| Chloroquine |
0.55% of maternal dose [100,102] |
No adverse effects |
Compatible with breastfeeding |
| Hydroxychloroquine |
0.35% of maternal dose [103,104] |
No adverse effects |
Compatible with breastfeeding |
| Sulphasalazine |
Sulphasalazine and sulphapyridine secreted at 5.9% of maternal dose [120] |
Well tolerated, 1 case of bloody diarrhoea [121] |
Allowed in the healthy full-term infant |
| Leflunomide |
No data published |
No data published |
Avoid because of theoretical risk |
| Azathioprine (AZA)/6-mercaptopurine (6-MP) |
AZA and its metabolites detected in milk [135] |
9 children nursed (AZA) without adverse effects, 1 child (6-MP) well |
Avoid because of theoretical risk |
| Methotrexate |
Excreted in low concentrations. Milk:plasma ratio of 0.08 [155] |
Not known |
Avoid because of theoretical risk |
| Cyclophosphamide |
Secreted (amount unknown) [172] |
Suppression of haematopoiesis reported in one nursing child [169] |
Contraindicated during lactation |
| Cyclosporine |
Milk:plasma concentration < 1; wide variability in drug disposition [188] |
No adverse effects observed in 9 breastfed children [188] |
No consensus, weigh risk/benefit |
| Tacrolimus |
Minute amounts secreted, nursing infant exposed to 0.06% of mother's dose [197] |
1 child nursed without side effects [197] |
Breastfeeding probably possible |
| Mycophenolate mofetil |
No human studies |
Not known |
Avoid because of theoretical risk |
| Intravenous immunoglobulin |
No data published |
Not known |
Breastfeeding probably possible |
| Etanercept |
Secreted at 0.04% of maternal dose [207] |
Not known |
Data inconclusive, weigh risk/benefit |
| Infliximab |
Secreted in small amount [211] |
Not known |
Avoid because of theoretical risk |
|
|
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|
Østensen et al. Arthritis Research & Therapy 2006 8:209 doi:10.1186/ar1957 |
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