Table 4

Immunosuppressive, cytotoxic and biological drugs during lactation

Drug

Secretion into breast milk

Effect on nursing infant

Breastfeeding allowed


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


Ă˜stensen et al. Arthritis Research & Therapy 2006 8:209   doi:10.1186/ar1957