Skip to main content

Table 5 Commonly used anti-rheumatic drugs and their use during breastfeeding

From: Managing pregnancy in inflammatory rheumatological diseases

Drug Crosses into breast milk Compatible with lactation
Paracetamol Amount too small to be harmful Can be continued during breastfeeding
Aspirin Possible risk of Reye syndrome In large doses, could impair platelet function Low doses (antithrombotic dose of 75 mg/day) acceptable, but avoid in large doses
NSAIDs Very small quantities in human breast milk Potential risk of jaundice and kernicterus Approved for use (use short-acting NSAIDs such asibuprofen)
Codeine Amount usually too small to be harmful; however, mothers vary in capacity to catabolize codeine and infant at risk of morphine overdose Use lowest effective dose if needed, but try to avoid
Pethidine Present in breast milk but not known to be harmful Can be used
Tramadol Amount probably too small to be harmful Should be avoided
Morphine Therapeutic doses unlikely to affect infant Withdrawal symptoms in infants of dependent mothers Therapeutic doses may be used if needed, but try to avoid
Corticosteroids Trace amounts of hydrocortisone and up to 25% of maternal levels of prednisolone detectable in breast milk Breastfeed 4 hours after last dose to minimize exposure if prednisolone of greater than 20 mg
COX-2 (cyclo-oxygenase-2) inhibitors Insufficient data in humans Avoid due to theoretical risk
Hydroxychloroquine Found in breast milk but no abnormalities reported Can be continued during breastfeeding
Methotrexate Excreted in low concentrations into breast milk Contraindicated
Leflunomide No published data available Contraindicated due to theoretical risk
Sulfasalazine Negligible amounts secreted in breast milk To be used with folic acid supplements
Gold salts Excreted in breast milk and absorbed by infant Can lead to rash, nephritis, hepatitis, and hematological problems Should be avoided
Azathioprine Azathioprine and its metabolites detected in breast milk in low amounts, but abnormalities rare May be used at not more than 2 mg/kg per day after discussion with mother weighing up risk-benefit
Cyclosporin Wide variability in drug disposition May be used after discussion with mother weighing up risk-benefit, preferably at doses lower than 2.5 mg/kg per day
Cyclophosphamide Excreted in breast milk Contraindicated
Mycophenolate mofetil No human studies Contraindicated due to theoretical risk
Tumor necrosis factor-alpha antagonists (for example, infliximab, etanercept, and adalimumab) Etanercept excreted in breast milk Infliximab undetectable No studies with adalimumab Not enough data, therefore should be avoided
Anakinra Unknown whether excreted in breast milk Not enough data, therefore should be avoided
Abatacept Not known whether excreted in breast milk or whether absorbed systematically after ingestion Contraindicated due to theoretical risk
Rituximab Unknown whether excreted in breast milk Not enough data, therefore should be avoided
Intravenous immunoglobulin weighing up risk-benefit No published data May be used during breastfeeding after discussion
Heparin and low-molecular- weight heparin Not excreted in breast milk Can be continued during breastfeeding
Warfarin Minimal excretion in breast milk Can be used while breastfeeding
  1. NSAID, non-steroidal anti-inflammatory drug.