Breastfeeding & plaquernil +Enbrel

[Maribel2twins]

Dear Dr Hale,
I'm 6 mpp pumping 42 opd for twins born at 35 weeks, I have a RA flare, and placed on plaquernil 2 months ago and now on Enbrel. They will be my first and only children, I'm so concerned that these meds will affect them but so torn to stop breastfeeding. I need your honest opinion what to do. I've read all the research there is on Enbrel including asking Amgen to test my breast milk for levels of Enbrel, they declined. I don't want to hurt in any way my babies. I'm also on Zoloft for post partum depression. I am an RN.

[admin]

Maribel2twins,

Plaquenil (Hydroxychloroquine) is rated an L2-limited data-probably compatible. The amount transferred into breast milk is 2.9% of your dose. Due to its huge volume of distribution, milk levels are generally quite low, and therefore this drug maybe considered compatible with breastfeeding. Monitor your infant for irritability, insomnia, vomiting, diarrhea, weight gain. With prolonged exposure monitor vision.

Enbrel (etanercept) is rated an L2-limited data-probably compatible. The amount transferred into breast milk is 0.07-0.2% of your dose. Three studies in breastfeeding women confirm that levels in milk are exceedingly low. No untoward effects were reported in any of the infants. Due to its enormous molecular weight (150,000 Daltons), it is extremely unlikely that clinically relevant amounts would transfer into milk in actively breastfeeding mothers. In addition, due to its protein structure, it would not be orally bioavailable in an infant. Etanercept was undetectable in infant plasma. All the authors suggest it should be quite safe for breastfeeding mothers and their infants. Monitor your infant for frequent infections.

Zoloft is rated an L2-limited data-probably compatible. The amount transferred into breast milk is 0.4-2.2% of your dose. Monitor your infant for sedation or irritability, not waking to feed/poor feeding and poor weight gain.


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