Announcement

Collapse
No announcement yet.

Humira, Enbrel, or Remicade for RA while breastfeeding

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • Humira, Enbrel, or Remicade for RA while breastfeeding

    Hi,
    I recently had a baby, he is almost 6 weeks old and I have been breastfeeding. I have had a flare up the last couple weeks due to RA and have taken 1 prednisone pack (5mg for 5 days, which helped so much) and now until I see my doctor in ten days I am prescribed to take 5 mg of prednisone everyday, is this safe to do for my baby? During this pregnancy and up till now I have been on no meds. B4 having children I took humira 40 mg injected in stomach every 2 weeks. After my first child was born I weaned to formula after 6 weeks and then took humira every week for about 8 months. I would really like to continue breastfeeding this time and am wondering which drug would be best to take between Humira, Enbrel, or Remicade? I read your article on how drugs pass into milk, and I would like to know which drug pases thru the least, out of all the possible ways it could pass thru? And if there is a chance, that in the best drug you reccomend, some of it could still pass thru to the milk I would like to know of that too....if its possible to know. Do you think breastfeeding while on a drug is still better than formula? If you have any other advice please let me know? Thank you so much for your time and information.....I so so appreciate it!

  • #2
    Mlund87:

    We do not have data on Humira. We do for infliximab(Remicade) and etanercept(Enbrel). Both the latter transfer into human milk very minimally. Only 0.07% - 0.154% of the dose of Enbrel enters milk, and only about 0.3% of infliximab enters milk. This is about as low as you can get.

    Neither have been found to cause problems for the breastfed infant. I would assume the same for Humira since it is largely the same product. Even if present in milk, they would only be digested like proteins and none would likely be absorbed.

    In my opinion, you and your infant are far better continuing to breastfeed while taking these medications than to formula feed. Lets face it, formula is hazardous for an infant. There is simply nothing that is as good as mothers milk for a newborn infant...nothing. Not even close.

    Tom Hale Ph.D.

    Comment


    • #3
      Thanks so much for your quick reply! Its nice to know that BFing while taking meds is safer than formula! I feel so much more confidant in my decision now! Again thank you so much!

      Comment


      • #4
        Dear pedsarnp,

        We do not have data on the amount of adalimumab (Humira) that enters breastmilk. Based on the kinetics of the drug, Dr. Hale thinks minimal amounts would enter the milk compartment. The drug also has low oral bioavailability so the infant would be unlikely to absorb quantities that would be clinically relevant through breastmilk. Live vaccines, in general, should not be used in immune compromised individuals. If there is concern for immune deficiency in this infant, getting titers of the other vaccines such as hepatitis B or rotavirus, to make sure the infant is making adequate immune response may be reassuring along with a CBC to make sure blood counts are within normal limits. These vaccines are attentuated, so as long as the infant has adequate immune response, are likely compatible with breastfeeding. Dr. Hale is currently out of town. When he returns, he will also post his opinion.

        Sincerely,
        Cindy Pride, MSN, CPNP
        TTUHSC InfantRisk Center

        Comment


        • #5
          Dear pedsarnp,

          I spoke with Dr. Hale, and he states that this infant should be able to receive live vaccines as the Humira would not be biologically active in the infant. The infant's GI system should destroy the small amount of Humira that may be present in breastmilk. Please call us at the InfantRisk Center if you have further questions. Our phone number is 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

          Sincerely,
          Cindy Pride, MSN, CPNP
          TTUHSC InfantRisk Center

          Comment


          • #6
            updated information on Enbrel?

            Hello- Do you have any new studies or updated information on the amount (if any) of Enbrel that is transferred to the breastmilk? I was reading a couple of the other forums and the latest information that I could find was this one from 2012. I was hoping that maybe there had been more studies done with more current information. I have RA, and I'm currently breastfeeding my 3 month old. I have struggled with the pain about as long as I can being off the Enbrel and I was going to stop breastfeeding so I could start my medication back, but since reading more about it, I'm hopeful that I can start Enbrel back and continue to breastfeed as well.
            Thank you for your time.

            Comment


            • #7
              Dear Cristi,

              It is probably safe to breastfeed while using Etanercept (Enbrel). This medication is a large molecular IgG protein. Three studies in breastfeeding women confirm that levels in milk are exceedingly low. No untoward effects were reported in any of the infants. Etanercept was undetectable in infant plasma. All the authors suggest it should be quite safe for breastfeeding mothers and their infants.

              Tassneem Abdel Karim, MD
              InfantRisk Center

              Comment

              Working...
              X