Medication questions

[BeachbumOT]

Hi.
I'm pregnant once again and planning to breastfeed. My medications are slightly different this time around, so I'm looking for advice. Here is my background:
Crohn's disease diagnosis at age 8
Currently 33
History of 2 resections (ileocecal and small bowel)

Medications are:
Apriso .375 gram capsules. I take 4 once daily
Mercaptopurine 50 mg daily
Probiotics
Prenatal vitamins.

I take all of my medications and supplements in the morning around breakfast time.

Thanks for all of your help! I look forward to hearing from you soon!!

[admin]

BeachbumOT:

You really need to speak with your OB about these drugs. Hopefully you can withdraw from them during pregnancy, as is often the case. But you'll need to have your OB decide which and how you should withdraw from. I'd suggest you get off mercaptopurine first and quickly, as its the worst of this group. Mesalamine (Apriso) is less hazardous to your fetus.

Tom Hale Ph.D.

[BeachbumOT]

Hi again.
Thank you for your feedback. I've spoken with my OB and two gastroenterologists this pregnancy, as well as 3 gastroenterologists when I was pregnant before and all have agreed that it is in my and baby's best interest to remain on my medication (including mercaptopurine). My question was regarding breastfeeding. What is your opinion regarding these medications and breastfeeding?

[Sandra]

BeachbumOT,

Apriso (mesalamine) is rated L3-limited data-probably compatible. The amount transferred in breast milk is 0.12-8.76% of your dose. Mesalamine contains 5-aminosalicylic acid (5-ASA) and acteyl-5-ASA which have both been found in breast milk. Numerous reports suggest milk levels of 5-ASA are quite low, generally less than 10% of the maternal dose. Watery diarrhea has been reported but this appears to be rare. It is commonly used in many patients without reported complications. Monitor the infant for vomiting, watery diarrhea, and mucous in the stools.

Mercaptopurine is rated L3-limited data-probably compatible. The transfer of the active metabolite (6-MP) into milk is quite low. However, this is a strong immunosuppressant and some caution is still recommended. Monitor the infant closely for signs of immunosuppression, leukopenia, thrombocytopenia, hepatotoxicity, and pancreatitis. The risks to the infant are probably low. Recent long-term data suggest that the rate of infections in treated groups is no different from non-treated controls.

I hope this helps. If you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks,

Sandra Lovato R.N.
InfantRisk Center