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Dose adjusted R-EPOCH and breastfeeding

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  • Dose adjusted R-EPOCH and breastfeeding

    I am going to be starting a chemo regimen called dose adjusted R-EPOCH tomorrow for lymphoma. My plan is to attempt pumping while going through treatment so that I can breastfeed my newborn once finished. How long afger my last treatment would it be safe to nurse? I tried searching the forums but couldn’t find any information on it.

  • #2
    Fcgirl23,

    R-EPOCH (rituximab, etoposide phosphate, prednisone, vincristine sulfate (Oncovin), cyclophosphamide, and doxorubicin hydrochloride (hydroxydaunorubicin)). With all of these medications the longest wait time is 35 days after your last dose of vincristine.

    Etoposide wait 2-3 days.

    Vincristine wait 35 days.

    Cyclophosphamide wait 3 days.

    Doxorubicin wait 7-10 days.

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

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    • #3
      Thank you. So do you not have to wait after rituximab? Just wondering if that would increase the time. I’ll also get Neulasta as part of my treatment regimen. Does that affect how long it would take to be safe to nurse?

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      • #4
        Fcgirl23,

        Rituximab is rated an L3-no data-probably compatible. "Rituximab, an IgG antibody is used in the treatment of non-Hodgkin's lymphoma, rheumatoid arthritis, and lymphoid leukemia. There are no reported levels in human milk, but due to its large molecular weight, it is unlikely to enter milk in clinically relevant amounts. In addition, the low oral bioavailability of this protein suggests little absorption in the infant's gut. Some caution is recommended, especially in the colostral phase, and each woman should understand the benefits and risk of using this type of medication in lactation." (Medications and Mothers' Milk database, Dr Thomas Hale PhD). Monitor your infant for fever, frequent infections, poor feeding/poor weight gain.

        Neulasta is rated an L3-no data-probably compatible. "It is probably too large to enter milk after the colostral period. It would not likely be orally bioavailable. There are no reported levels in human milk. Due to large molecular weight of this drug, milk levels and oral bioavailability are likely to be low. Lactation studies in rodents did not show any untoward effects on growth and development of breastfed rodents." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

        Sandra

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        • #5
          Sorry last question. The milk that I pump in those 35 days: dump it or will it be safe for consumption after the 35 days?

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          • #6
            Fcgirl23,

            Dump it.

            Sandra

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