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I was consulted to evaluate a lactating mother who is 26 days postpartum and has been diagnosed with an ovarian vein thrombosis. She has had high fevers, abdominal tenderness, and positive blood cultures. Our infectious disease specialist has changed her antibiotic from Zosyn to Invanz (ertapenem), which she will continue at home for two weeks, and has also advised her to pump and dump. There is minimal information on Lactmed and the medication is not addressed in Dr. Hale's 2014 book. Any new evidence on the safety of ertapenem in a lactating mother? Thank you.
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Hi, thanks for your post.
The only available information on breastfeeding with ertapenem comes from the clinical trials conducted by the manufacturer (as described in the prescribing information). Unfortunately, the way they collected the data makes it very difficult to estimate what an infant's exposure would actually be throughout the day. If we assume a few things, we end up with a relative infant dose of around 0.4%. The truth is likely to be on that order of magnitude. This is similar to the values we have calculated for meropenem. Accounting for ertapenem's very poor oral bioavailability and the uncertainty we have about the RID, we give this drug an L2 safety rating (out of 5) ("Safer"). Your patient should be able to breastfeed without a pump-and-dump regimen or any other special considerations. Watch the child for new rashes or changes in bowel habits.
Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519
-James Abbey, MD -
I am looking for some help with breastfeeding and Enbrel. I take Enbrel for psorasis and have been off of it since I got pregnant. My baby is almost 3 months old and I was going to try and stay off the Enbrel, but no topical meds are touching it and it seems to be worse than it has ever been. It is taking over my entire body, even my face. It has become quite painful now. I have studied it and I know the studies in the past have shown it is excreted in the milk minimally, but most info I have found is from 2010 or 2011. Just wondering if there were any new recommendations. If it is potentially safe, what about immunizations for the baby? Is there a risk with them and the immune suppression potential???Thx for any light you may shed on this!!Comment
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Hi, thanks for your post.
There have not been any new studies published since 2011. These earlier studies demonstrated only minimal secretion of etanercept (Enbrel) into the breastmilk, and in all cases, the drug was undetectable in the baby. These findings are consistent with predictions based on the chemical properties of the drug itself. A very large molecule like etanercept has difficulty getting into the milk and protein-based drugs are easily destroyed if swallowed. Based on our current knowledge of this medication, we give it an L2 safety rating (out of 5) ("Safer"). It is very unlikely to suppress the baby's immune system in any way.
Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519
-James Abbey, MDComment
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