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Rituxamab and breastfeeding

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  • Rituxamab and breastfeeding

    Dr. Hale - I would love to get your expert opinion on breastfeeding after a Rituxamab infusion. My daughter is 8 months, full term and not on any medication. I actually conceived her a month after my 2nd Rituxamab infusion. I had a normal pregnancy and she was born healthy and full term. We have a wonderful nursing relationship that I'm not ready to let go yet, but my neurologist wanted me back on Rituxamab bc I had a major flare after my first born son. I read conflicting info on this forum and I am not sure if I can continue nursing my daughter after my infusion last week. So far I am pumping and dumping and really really hope to nurse her again. I'd really appreciate if you can reply.

  • #2

    In your situation with an 8 month old infant, I'd suggest the risk to your infant is probably quite low. For two reasons, one is that the dose via milk is probably quite low, as we've seen with other monoclonal antibodies, and two, at 8 months most mother's milk supply begins to wane and the volume goes down. This is normal, but it also means that the oral dose of the drug is signifcantly reduced to the infant.

    But we don't have any experience with this drug in breastfeeding mothers so we are a little tentative about its use. Certainly, it is a large monoclonal antibody, which is unlikely to enter milk which is good. But it also could suppress the gut's immune system to a limited degree.

    In a newborn, this would be somewhat more risky. At 8 months postpartum, I think the risk is low.

    Tom Hale, Ph.D.


    • #3
      thank you Dr. Hale. I really appreciate you getting back to me on this matter.


      • #4
        hi again Dr.Hale

        I have been pumping and dumping, hoping to make it to 22 days since that's the half life of Rituxan so I can continue to breastfeed. Would that make any difference on the "risk" that you're referring to? Also, what do you mean by "risk"?what should I watch out for after I breastfeed my child with my recent exposure to the drug? Thanks again.


        • #5

          The half-life is 22 days so it could make a slight difference, however it takes 6 half-lives to be completely out of your system and your milk supply may suffer, but the decision is up to you. We would say if your infant is thriving and gaining weight you could go ahead and breastfeed. Side effects to watch for are f[COLOR=#333333][FONT=lucida grande]ever, vomiting, weight gain, frequent infections.

          Sandra Lovato R.N.
          InfantRisk Center


          • #6
            Hello Dr. Hale and all, I am about to undergo initial rituximab infusion. My child is 18 months, without any change before the day of infusion he will be nursing once in the morning, several times in the evening hours, and one to three times overnight.

            Should I wean my child before initiating rituximab treatment?

            I am also taking Plaquenil and Prednisone occasionally.


            • #7

              "There are no reported levels in human milk, but due to its large molecular weight, it is unlikely to enter milk in clinically relevant amounts. In addition, the low oral bioavailability of this protein suggests little absorption in the infant's gut." (Medications and Mothers' Milk database, Dr Thomas Hale PhD). We think this medication is a low risk to a breastfed infant, and transfer into breast milk expected to be exceptionally low, but each mother needs to understand the risk and benefit of using this type of medication. Monitor your toddler for fever, frequent infections, poor feeding/poor weight gain.

              Sandra Lovato R.N.
              InfantRisk Center