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  • prednison,plaquenil and pumped milk?

    Hi, I am a pediatrician and lactation consultant from Belgium
    I have a question for a new mom with a baby of 8 weeks old. She is currently breastfeeding and was diagnosed with reumatoid arthritis last week. She is anxious about continuing to breastfeed whilst taking prednison (10 mg once daily) ans plaquenil (200 mg twice a day). Although these are L2 medications, her doctor told her that it would be better not to breastfeed until 6 months or longer so now she believes the medication might be harmful to her baby. Two questions:
    - is there a cumulative effect of the medication after a while which could be hazardous to the child (since plaquenil has a T1/2 of 40 days), or can this mom be reassured that she can contunue breastfeeding even for several months
    - how about pumping her milk and storing it in the freezer. Is the medication going to have an effect on the quality of the milk (or the taste?)? If not, how long can the milk be preserved in the freezer?
    Thanks a lot

  • #2
    Dear cb170574

    I just discussed your question with Dr. Hale. Hydroxychloroquine (Plaquenil) is an effective medication in treating rheumatic arthritis, it does have a huge volume of distribution, and milk levels are generally quite low. However, in this case we think there is some risk, although quite small. This medication if used over a prolonged period may produce significant retinal damage.

    We suggest using another alternative, such as the TNF blockers like, Infliximab or Entarecept, which are probably both quite safe for breastfeeding mothers and their infants. For more information, please call the InfantRisk Center at 806-352-2519, Monday through Friday, 8-5pm.

    Tassneem Abdel Karim, MD
    InfantRisk Center

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    • #3
      cb:

      we don't know much about the safety in pregnancy. Most studies seem to suggest it is probably safe. Below are some data on infliximab and etanercept.

      As for pumping and storing milk with these products. This won't affect the level of drug at all...its still there.

      Tom Hale Ph.D.

      ---------

      Infliximab is a monoclonal antibody to tumor necrosis factor-alpha (TNF-alpha) used to treat Crohn's disease and rheumatoid arthritis. There have been some case reports of complications, but one study with 96 pregnant women exposed to infliximab concludes that there are no adverse effects. While considered reasonably safe during the first two trimesters, most authorities recommend discontinuing infliximab by the third trimester.[1-3]

      Since infliximab does not cross-react with TNF alpha in species other than humans and chimpanzees, animal reproduction studies have not been conducted with infliximab. No evidence of maternal toxicity, embryotoxicity or teratogenicity was observed in a developmental toxicity study conducted in mice using an analogous antibody that selectively inhibits the functional activity of mouse TNF. Doses of 10 to 15 mg/kg in pharmacodynamic animal models with the anti-TNF analogous antibody produced maximal pharmacologic effectiveness. Doses up to 40 mg/kg were shown to produce no adverse effects in animal reproduction studies. It is not known whether infliximab can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.

      ----------

      Etanercept: There are no adequate and well-controlled studies in pregnant women. There have been several reports of normal pregnancy outcomes after etanercept exposure.

      Developmental toxicity studies have been performed in rats and rabbits at doses ranging from 60 to 100 fold higher than the human dose and have revealed no evidence of harm to the fetus due to etanercept. There are, however, no studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.[1]

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