Entocort vs Pentasa for Breastfeeding

[Lindsaym]

Hello!

I have been recently diagnosed with Crohns Disease and my Gastroenterologist has given me the choice between:

3mg oral Entocort 3X per day (9mg total daily) for 8-12 weeks OR
1g Pentasa 3X per day for an indefinite period of time

I am breastfeeding my 3 month old (healthy, born via induction at 41 weeks) and would like to continue but am VERY, VERY concerned with taking these medications and introducing them to her via my milk. I have received very conflicting advice from my gastro physician (says Entocort is ok), our PCP (not comfortable with me continuing to BF), and the pharmacist (also not comfortable with my continuing to BF) Please let me know if:
- these medications are compatible with breastfeeding
- which one is safest if they are compatible
- effects of these drugs on an infant
- what to look for if a reaction is happening to her

I very much appreciate any and all information you can give me to decide on a course of action.

Thank you again

Lindsay

[Sandra]

Lindsaym,

Entocort (budesonide) is rated an L1-extensive data-compatible.[COLOR=#333333][FONT=lucida grande] Budesonide, however used, is a preferred steroid for breastfeeding women. It is rapidly cleared by the liver. It is poorly absorbed orally. And it produces the least adreno-cortical suppression when compared with many of the other oral steroids (predisone(20mg/d)=78% vs budesonide(9mg/d)=45% adrenal suppression). Steroids in general due to structural problems, enter milk poorly. Only 0.3% of your dose is transferred into breast milk. Monitor the growth and development and weight gain of the infant.

Pentasa (mesalamine) is rated an L3-limited data-probably compatible. The amount transferred into breast milk is 0.12-8.76% of your dose. [/FONT][/COLOR]Commonly used in many patients without reported complications. Observe infant for gastrointestinal symptoms such as watery diarrhea, mucous in the stools and vomiting. As long as the infant is not symptomatic it should be ok to use this medication.

I hope this helps.

Sandra Lovato R.N.
InfantRisk Center
806-325-2519

[Lindsaym]

I am now currently on Entocort and continuing to breastfeed. The next step for long term maintenance of my Crohns is going to be Pentasa. Can you build a little on the information for Pentasa. Is the 0.12%-8.76% clinically relevant? If it is having an immune suppressing effect in my body, will that happen to her? What is the half life of the medication? Would it be helpful if I timed it and took it after her feedings? Everything I am reading refers to the metabolite of mesalamine transferring into the milk and not the actual mesalamine...what does that mean? Is the metabolite considered to have less of an impact than the actual medication? My gastroenterologist is not comfortable with me continuing to breastfeed on Pentasa but you and Dr Hale are the experts in this. I suppose I'm trying to understand the minutia of this medication so I can make a very informed decision. Thank you in advance for taking the time to answer my questions.