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Table 4 Immunosuppressive, cytotoxic and biological drugs during lactation

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