Long term use of lialda and breastfeeding

[Rrent12]

Hello,
I was diagnosed with UC two weeks postpartum and have been on prednisone (currently on 15mg) and lialda (2.4 grams) daily. I will be off prednisone in about two weeks and will remain on lialda. I was initially discouraged from breastfeeding by doctors and so I stopped. However, after consulting with several lactation nurses they appeared to support my breastfeeding after reviewing risks and so I opted to continue. My question is regarding the lialda. Is it safe to continue breastfeeding long term if I continue to take this medication? I will need to continue taking it as a maintenance medication. I understand that I should be observing for diarrhea. I've noticed that my baby is spitting up often and am concerned that this may be a side effect as I read on another post that we should also observe for vomiting. Is there anything I can do to reduce exposure? I take lialda with breakfast. I've been waiting four hours after taking prednisone to breastfeed in order to reduce exposure. Is this necessary on the dosage I'm currently taking? I was initially started on 40mg/day but have been tapering off weekly. My baby is two months old. How much of both medications is he actually exposed to? Please advise. Thank you.

[Sandra]

Rrent12, thanks for posting,

Prednisone is an L2-limited data-probably compatible. The amount transferred in breast milk is 1.8-5.3% of your dose. The main concern is using high doses (greater than 40mg a day) for prolonged periods of time (greater than
3-4 weeks). It has a half-life of 2-3 hours, so take it right after you breastfeed so you have a longer break period and potentially half the medicine is out of your system. Monitor the infants growth and development.

Lialda (mesalamine) is an L3-limited data-probably compatible. The amount transferred into 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. Commonly used in many patients without reported complications. Monitor the infant for vomiting, watery diarrhea, and mucous in the stools.

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