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  • Breastfeeding while on Humira.

    Dear Dr Hale,

    I have a severe psoriasis and psoriatic arthritis. I am currently breastfeeding my baby. I was on Humira before I got pregnant. I would like to get back on humira again coz my symptom is really bad right now but I am not sure is it safe to breastfeed while on humira. I don't want to harm my baby. should I stop breastfeeding and give him formula? Please help me, I don't know what will be best for us.

    Thank you,
    Warunee

  • #2
    warunee:

    By no means stop breastfeeding. We do have some data on Humira which suggests its transfer into human milk is very low with a relative infant dose of only 0.12%. This is exceedingly low. Even this amount present in the babies gut, would be largely metabolized like any other protein, and not really absorbed systemically to any degree.

    Studies in two infants suggested levels in milk were negligible and of no consequence.

    Tom Hale R.Ph., Ph.d.








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    • #3
      Hi Dr Hale,

      Thank you for the information above... I have a similar question.

      I have been diagnosed with Ankylosing Spondilitis, and have been prescribed Humira. I have not yet started, as I'm feeling anxious about the possible effects on bub, even though most things I'm reading suggest that it "should be" or is "probably" safe.

      My bub is now 15 months old, but we weren't planning to ween just yet and he still feeds quite frequently during the night...
      I turn 39 this year, and so don't want to put off trying for another baby too long, and would definitely stop any medication before trying to conceive. I feel if i was going to try the medication, it would need to be soon, or I may need to wait another couple of years (conception/pregnancy/breastfeeding) before trying.

      My questions are;
      What would happen if any Humira was absorbed by the baby?
      Are there any recommended strategies for maximising safety if you do breastfeed while on Humira?
      Given my child is older (and so breast milk is not his only source of food), do the risks outweigh the benefits of breastfeeding?
      How long before trying to concieve should i stop taking Humira?

      Thank you so much for your help - I'm feeling very conflicted!

      Apologies if this is posted in the wrong place - I've never really used a forum before.

      Vanessa

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      • #4
        Vanessa:
        ---What would happen if any Humira was absorbed by the baby?
        I doubt anything would happen if small amounts were absorbed. The dose would simply be too low to produce any complications. At the very worst, he might have a higher risk of infection in the gut. But again this is so unlikely its not worth worrying about.

        ---Are there any recommended strategies for maximising safety if you do breastfeed while on Humira? No. at 15 months the amount of milk you produce is low. I wouldn't worry about it.

        ---Given my child is older (and so breast milk is not his only source of food), do the risks outweigh the benefits of breastfeeding? The risks are nil. Benefits far outweigh any risk.

        ---How long before trying to conceive should i stop taking Humira? This is a question for your OB. I'd suggest several months. Humira is a large IgG molecule and would not transfer through the placenta in the first 2 trimesters. Remember to take your prenatal vitamins with FOLIC acid BEFORE trying to get pregnant.

        Tom Hale Ph.D.

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        • #5
          Hi again Dr Hale,

          I did go ahead with the Humira, but have now been moved to another medication, Enbrel... I just wanted to check whether the same answers to the questions I had asked about Humira apply? Are there any other risks with the Enbrel, or is it essentially the same type of drug? Does the frequency of injection (weekly as opposed to fortnightly) affect the level of risk?

          Thanks again for your help - I really appreciate it!
          Vanessa

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          • #6
            Vanessa:

            Its just another similar monoclonal antibody like Huimira. About 0.07% - 0.154% transfers into milk. Yes, the frequency of your injections 'might' produce slightly higher levels in milk, but not enough to worry about.

            Tom Hale Ph.D.

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            • #7
              Hello,

              Can I kindly ask your up-to-date opinion for breastfeeding while on humira? My son is 6 months old and he is feeding only on milk right now. He is 9,5 kgs, and 73 cms. From previous posts, I had the feeling that if the baby is smaller, it has a higher risk for side-effects.

              And if humira stays in mother for approximately 2 weeks, and has a peak around day 6 (this info is from some academic researches I found with internet search), doesn't it accumulate in the infant with every feed and reach a higher % that can exceed the risk levels in the infant body? Please help me weight the pros and cons.

              Thank you very much.

              Best Regards,
              Figen
              Last edited by Figen Vasileva; 11-13-2017, 11:07 AM.

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              • #8
                Figen Vasileva,

                Humira has a very low transfer rate. We advise that even young infants can continue to breastfeed as long as they are not symptomatic. Monitor for vomiting, fever, weight gain, and frequent infections.

                This is Dr Hales previous post:

                "By no means stop breastfeeding. We do have some data on Humira which suggests its transfer into human milk is very low with a relative infant dose of only 0.12%. This is exceedingly low. Even this amount present in the babies gut, would be largely metabolized like any other protein, and not really absorbed systemically to any degree.

                Studies in two infants suggested levels in milk were negligible and of no consequence.

                Tom Hale R.Ph., Ph.d."

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


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