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filgrastim injections & breastfeeding

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  • filgrastim injections & breastfeeding

    Hello, I am starting filgrastim injections in two weeks for a bone marrow donation through pbsc. My local LLL advised me to ask here if it's possible to nurse during that time. I was told from the hospital to stop nursing. Thank you a lot for your time!!!

  • #2

    Filgrastim is a large peptide that stimulates bone marrow production. It is not orally bioavailable, and because of its size, it would likely not enter milk as well, or in clinically relevant amounts.

    I'd suggest it is probably safe for you to breastfeed while receiving this preparation.

    Tom Hale Ph.D.

    Filgrastim is a large molecular weight biosynthetic protein used to stimulate neutrophil production. It is more commonly called granulocyte colony stimulating factor (G-CSF).[1] There are no data on its entry into human milk, but due to its large molecular weight (18,800 daltons) it is extremely remote that any would enter milk. Following use, the plasma levels in most individuals are often undetectable or in the picogram range. Further, due to its protein structure, it would not likely be orally bioavailable to the infant.

    T1/2 = 3.5 h
    MW = 18,800


    • #3
      Then why an L4?

      If this is the case, then why does the Infantrisk app classify filgrastim as an L4?


      • #4
        The InfantRisk app is connected to our live database, which we are constantly updating. In this case, new information revealed that drugs like filgrastim survive the stomach acid can be absorbed via a dedicated transport protein in the infant intestine. L4 means that the drug is probably compatible with breastfeeding, but only with a significant qualifier. We recommend that infants exposed to filgrastim should be monitored for changes in their white blood cell counts in order to ensure their safety. If future case reports demonstrate that incidental exposure via breastmilk has little effect on the baby, we may adjust it back to an L3.

        -James Abbey, MD


        • #5
          What is the filgrastim injections is this for pregnant women medicine ?


          • #6
            Animc, thanks for posting,

            I think you are asking about the safety of filgrastim in pregnancy. Filgrastim is given an P3 rating for pregnancy which means unknown, that the risk to the fetus cannot be ruled out. Here is the information we do have about it:

            Currently, there are no data available about the use of filgrastim and the risk to the developing fetus in human pregnancy.[1] It is known that filgrastim can cross the placenta from scientific reports when it was given to a woman < 30 hours before delivery of a preterm infant (< 30 weeks). The effects of filgrastim in pregnancy have been studied in both rats and rabbits. No signs of teratogenicity were reported with either animal; however, filgrastim has been shown to have adverse effects in pregnant rabbits when given at doses 2-10 times higher than human doses. In pregnant rabbits demonstrating maternal toxicity, reduced embryo-fetal survival (at 20 & 80 mcg/kg/day) and increased abortions (at 80 mcg/kg/day) were reported. In pregnant rats, no maternal or fetal effects were observed at doses up to 575 mcg/kg/day. The offspring of rats given filgrastim during pregnancy and lactation had a delay in external differentiation/growth (at ≥ 20 mcg/kg/day) and a slightly reduced survival rate (at 100 mcg/kg/day).

            I hope this helps, if you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks,

            Sandra Lovato R.N.
            InfantRisk Center