Azathioprine, prednisone, plaquenil & moclobemide

[Piatamar]

Hello,

I am writing to ask about the safety of breastfeeding my 3 month old while taking 50mg azathioprine, between 5 and 20mg prednisone, 400mg plaquenil and 750mg moclobemide for depression. I have been advised by drs that these are all safe/worth staying on, but am unsure if I should be timing when I take them to avoid peak levels in milk. Different sources seem to quote different studies so am a little unsure.

Thank you very much for the information you provide.

[Sandra]

Piatamar,

Azathioprine is rated an L3-limited data-probably compatible. The amount that transfers into breast milk is 0.07-0.3% of your dose. The half-life of this medication is 2 hours. With any medication take it right after nursing so you have a longer break before nursing again. Monitor your infant for signs of immunosuppression, leukopenia, thrombocytopenia, hepatotoxicity, pancreatitis. If signs of immunosuppression or anemia check CBC; if signs of liver dysfunction (yellowing of skin or whites of eyes) check liver enzymes and bilirubin.

Prednisone is rated an L2-limited data-probably compatible. That amount that transfers is 1.8-5.3% of your dose. The half-life is 2-3 hours. Monitor for feeding, growth and weight gain; could consider a CBC with prolonged exposure.

Plaquenil is rated an L2-limited data-probably compatible. The amount that transfers is 2.9% of your dose. The half-life is >40days. Monitor for irritability, insomnia, vomiting, diarrhea, weight gain. With prolonged exposure monitor vision.

Moclobemide is rated an L4- no data-possibly hazardous. We do not know how much transfers into breast milk, but believe it will be minimal amounts. "Unlike older MAO inhibitors, moclobemide is a selective and reversible inhibitor of MAO-A and thus is not plagued with the dangerous side effects of the older MAO inhibitor families. In one study the average milk concentration throughout the 12 hour period was 0.97 mg/L hour. The minimal levels of moclobemide found in milk are unlikely to produce untoward effects according to the authors. Do not use with SSRIs, clomipramide, tricyclic antidepressants, pseudoephedrine, ephedrine, phenylephrine, epinephrine and other stimulants." (Medications and Mothers' Milk database, Dr Thomas Hale PhD). Monitor for sedation or irritability, insomnia, not waking to feed/poor feeding, constipation, weight gain. Dr Hale thinks this medication is probably ok as long as you do not mix with medications that could cause adverse side effects if taken in conjunction with MAOI's, such as those listed above. The half-life of this medication is 1-2.2 hours.

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