Breastfeeding and MS

[Sandra]

KimmySue,

The pump and dump is a recommendation to help reduce the exposure of this medication in your infant. You can try waiting 3-4 hours and as long as your infant is not symptomatic you can continue to nurse without pumping, that is up to you.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[KimmySue]

Is there any additional information about the two copaxone maternal cases? What is considered shortly after?
Is it necessary to pump and discard if the medication is taken after a feeding and 3-4 hours before the next feeding?

[admin]

Vanina78,

Copaxone (glatiramer) is still a L3-no data-probably compatible. There is not any new data on this medication. "We have had 2 maternal case reports of infants that itch and scratch their face when breastfeeding shortly after the mother takes glatiramer. Suggest pumping and discarding milk after glatiramer administration and then waiting 2 hours before breastfeeding." (Medications and Mothers' Milk database, Thomas Hale, PhD.)

Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[Vanina78]

I'd like to know if there's updated information about breastfeeding with copaxone.
I had my first daughter in 2011 and doctors didn't allow me to combine this medication with bf. Now I'm 8 months pregnant and and I'd like to nurse my baby.
Thanks a lot!

[Sandra]

Lozwo,

Copaxone (glatiramer) is rated an L3-no data-probably compatible. [COLOR=#333333][FONT=lucida grande]There are no data available on transfer of glatiramer into milk, however it is highly unlikely due to its large molecular weight. It is probably okay to use during breastfeeding. We have had 2 maternal case reports of infants that itch and scratch their face when breastfeeding shortly after the mother takes glatiramer. We suggest pumping and discarding milk after glatiramer administration and then waiting 2 hours before breastfeeding.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519[/FONT][/COLOR]

[Lozwo]

Oh no I was waiting on this does this change the current idea that copaxone is fairly safe due to it's large molecule size ?

[Sandra]

Lozwo,

The copaxone study was cancelled because Dr Hale and the drug company found they were unable to analyze this medication.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[Lozwo]

Just wanting to know if there has been any progress on the copaxone study ?

[admin-james]

Hi, thanks for your post.

A few specific studies about the behavior of Rebif in human milk suggest that the amount that makes it to the baby is very small, and even less of that is actually absorbed by the baby's gut. These studies, however limited, have prompted us to rank Rebif as safer than other immunemodulator drugs in the same class that should be similar in theory. We cannot say for certain that Rebif is safe for breastfeeding, but limited evidence suggests that the risk is small. Weigh that against the benefits for your disease process and your improved ability to take care of your child.

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

-James Abbey, MD

The following references may be useful to your physician if he or she needs more information:

Chofflon M. Recombinant human interferon beta in relapsing-remitting multiple sclerosis: a review of the major clinical trials. Eur J Neurol 2000; 7(4):369-380.

Hale TW, Siddiqui AA, Baker TE. Transfer of Interferon beta-1a into Human Breastmilk. Breastfeed Med. 2012 Apr;7(2):123-5.

[chaosinoneself]

Hi. My son is now 12 weeks old. I was diagnosed in 2006 and have been symptom-free for the past five years while taking Rebif. I went off Rebif before getting pregnant. My neurologist would like me to go back on; however, she is concerned that there is not enough data to support taking Rebif while breastfeeding. My pediatrician referred us to Dr. Hale's book, which I think refers to Avonex (an intermuscular version of interferon beta-1a)? Can you give me any information that I can share with my neurologist about Rebif? Are other DMDs considered to be safer while nursing?
Many thanks.

[Lozwo]

Hi there!

I see this post was written some time ago and wondering about more recent breast milk studies on Tysabri? I'm currently nursing my 2 week old, however my neuro wants me to start on tysabri. I would be devastated to have to give up, but also am wanting to take the meds as I have been off them nearly 3 years now because of two pregnancies and Breastfeeding. Every doctor just tells me I can't can you offer any more current research ?
Thank you
Lozwo

[Missy13]

I am newly diagnosed with MS. I am currently breastfeeding a toddler and hoping to conceive again soon. My neurologist advised me that none of the medications for MS are compatible with breastfeeding, but of course I wanted to check on the available information before accepting that statement. I am also very curious about the copaxone study and what info has been found. I am content to delay the start of treatment until after we have our next child (provided that doesn't take us too long), but I do not want to have to cut breastfeeding short in order to start my treatment.

[knedmama]

copaxone, older nursling

Hi! I've just been diagnosed with MS after my first known exacerbation, where I had IV
high dose methylprednisolone for a week. My son is nearly weaned, at age 3 and a half,
but after the steroids course and another ~5 days before deciding that it was safe for him to
resume so we could end our nursing relationship a little less abruptly, he has nursed for a minute or two every few days when he asks. I expect that between his age, the 10+ days without nursing or engorgement during the steroid treatment, and the very occasional frequency of nursing as he finishes weaning, he's not even getting more than few drops of milk anymore.

I am soon to start daily injections of copaxone, and wondering if there has been any progress on the study on copaxone, and whether the molecule size and the amount of milk obtained by an older child who nurses for a brief check-in a few times a week would be reason to feel comfortable with finishing weaning at his pace rather than a second and final abrupt ending when I begin the copaxone.

[Epal]

Hi Cindy, I was wondering if you had any updates on the Copaxone study. I was telling my neuro about it today and was wondering about its progress.

Thanks!

[cpride]

Dear Legna,

Minute amounts of Gadolinium enter breastmilk. Dr. Hale recommends to pump and discard at three hours after the dose then resume breastfeeding. This time frame allows 75 percent of the drug to be eliminated. Waiting 9 hours would allow all of the drug to be eliminated. Virtually none of the drug is absorbed orally by the breastfeeding infant.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center