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Infliximab and breastfeeding

Following on from the page on Azathioprine I thought it would be useful to add data on infliximab which is also widely used by breastfeeding mothers. Like most of the biologicals the molecules are too large to pass into milk.

This information is taken from Breastfeeding and Medication

In 2002, the NICE (NICE 2002) recommended that this drug be only used for the treatment of severe, active CD when treatment with immunosuppressant drugs and corticosteroids is not tolerated or has failed.

It is now much more commonly prescribed to pregnant and breastfeeding women.

Infliximab is a large molecular weight antibody and preliminary results suggest it is too large to pass into breastmilk and it is not orally bio-available. It is distributed primarily in the vascular compartment and has a terminal elimination half-life of 8 to 9.5 days.

It is suggested that use by a mother should not preclude breastfeeding based on this data (Peltier 2001; Forger 2004; Mahadevan 2005; Basilisks 2006).

The BNF states that the amount in breastmilk is too small to be harmful.

Compatible with breastfeeding due to poor bio-availability and hence low-level absorption by the infant.

Infliximab is usually either not detectable in breastmilk or detectable at very low levels. Absorption of the drug from milk by the infant is minimal. Follow-up of infants exposed in utero and breastfed during maternal infliximab therapy have found no adverse effects and normal development. The measurement of minute concentrations in the milk of some women raises the possibility of local immune suppression in the gastrointestinal tact, but levels were not high enough to be of concern for systemic immunosuppression (LactMed)

References

  • Forger F, Matthias T, Oppermann M Becker H, Helmke KInfliximab in breastmilk, Lupus, 2004;13:753. Abstract NICE Crohns Disease – infliximab 2002
  • Mahadevan U, Kane S, Intentional infliximab use during pregnancy for induction or maintenance of remission in Crohn’s disease, Aliment Pharmacol Ther, 2005;21:733–8.
  • Peltier M, James D, Ford J, Wagner C, Davis H, Hanauer S Infliximab levels in breastmilk of a nursing Crohn’s patient, Am J Gastroenterol, 2001;96(9 Suppl. 1):S312. Abstract.
  • Vasiliauskas EA, Church JA, Silverman N, Barry M, Targan SR, Dubinsky MC, Case report: evidence for transplacental transfer of maternally administered infliximab to the new born, Clin Gastroenterol Hepatol, 2006;4:1255–8.

Any queries please contact me on wendy@breastfeeding-and-medication.co.uk

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