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Breastfeeding and Anti VEGF injection for macular degeneration

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  • Breastfeeding and Anti VEGF injection for macular degeneration

    Hi,

    I was recently diagnosed with macular degeneration in one eye and the retina specialist has prescribed treatments of Anti VEGF injections in that one eye, once per month for the next 2-3 months and then less frequently after that. I have received one injection so far, and I am due to receive another this Friday, 8/20.

    The retina specialist was uncertain if it would be safe for me to breastfeed after receiving my first injection. (He suggested waiting 24-48 hours before nursing and dumping the milk pumped during that time, but wasn't certain exactly how to advise me). So, AFTER I received the FIRST injection I called the Infant Risk nurse hotline BEFORE breastfeeding. The nurse who answered my call consulted with a Dr. and I was told that it would be fine to breastfeed as the quantity of product in the injection was very small (and I think they said it didn't pass the milk barrier??), so I proceeded to breastfeed as usual.

    When I returned for a follow up check the retina specialist asked what I had done about breastfeeding. I told him what I had heard from Infant Risk. It seemed he had done some investigating since my last visit and was concerned that perhaps I should wait 1-2 weeks before breastfeeding, and indicated that Anti VEGF did indeed pass the milk barrier. He did also mention that this treatment was used directly on premature babies to prevent blindness, so perhaps it was indeed safe.

    I am writing today to receive further clarification on what the best course of action you would advise. I found this article.
    [url]https://www.aop.org.uk/ot/science-and-vision/research/2019/09/18/research-shows-anti-vegf-drugs-excreted-in-breast-milk[/url]

    Overall, the retina specialist does not presume to be an authority on the safety of this treatment with breastfeeding, so I am hoping to get some more authoritative advice. Is this treatment not contraindicated at all? Should I wait 24-48 hours? Should I wait 1-2weeks?
    I am very concerned that if I don't breastfeed for 1-2 weeks my baby may not return to the breast, and I don't know how I would pump enough milk to last that long! (not to mention dumping 1-2 weeks worth of milk!).

    My baby is 8months old, full term and nurses 4x daily.

    Thank you so much for your help!

  • #2
    I found out that the specific name of the injection is BEZACIZUMAB (Avastin)

    Comment


    • #3
      Hi jend,

      I’m sorry that you have had such a difficult time getting answers and that we contributed to your confusion. Please allow me the opportunity to clarify.

      To answer medication requests, we do an in-depth analysis of existing research and synthesize the information in a clinically useful and easy-to-digest manner. We try and give short, concise answers to complex problems. This reductionistic approach sometimes means you don’t get the level of detail that you are looking for.

      Results from studies on medications and breastmilk can be challenging to break down. The research is often performed by scientists who are experts in their own field. Unfortunately, this means that personnel with expertise in lactation are often not involved in the study (we're rare!). The study you mentioned falls into this category.

      The research still offers us valuable and difficult-to-come-by information, but the results require some expertise for interpretation. Of the three cases analyzed, only one case was producing mature milk under acceptable conditions. The other cases were during very early or very late-stage milk production when lactocyte barriers are not entirely intact. In these two cases, we would expect an atypical transfer of the drug into milk. Analysis of ranibizumab in the one case with mature milk production was unable to detect any drug in milk. There have been a few reports for bezacizumab, all of which were unable to detect any drug. This result is consistent with our pharmacokinetic estimates of drug transfer. It supports our belief that the amount of this drug an infant would receive through milk is not likely to be clinically relevant.

      Even further, these drugs are administered by injection because they are 1) degraded in the acidic environment of the stomach and 2) if drug survived, it is too large to be absorbed in the GI tract. Again, this leads us to believe it would be safe for a breastfeeding mom to take.

      Lastly, there is discussion about the potential effects of these drugs on the composition of milk. The study you mentioned supports that anti-VEGF drugs decrease the amount of VEGF in breast milk. However, it is not known what benefit VEGF in breastmilk has to infants. VEGF is not a component of infant formulas, so this is not an argument against breastfeeding while on the drug but more of a theoretical discussion.

      In summary, we don’t have much research available to provide and what we do have must be used with a critical eye. Ultimately, we do not believe a clinically relevant dose of drug would reach the infant or that it would cause harm in your scenario. Due to the long half-life of these drugs, waiting after the injection would not be of much benefit. I suggest continuing to breastfeed as normal.

      If you have any further questions, I suggest that you or your retina specialist give us another call.

      Best,
      Kaytlin Krutsch, PharmD

      Comment


      • #4
        Thank you so much! This is very helpful! It definitely eases my mind and the concerns and questions that my retina specialist had.

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