From: Anti-inflammatory and immunosuppressive drugs and reproduction
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 |