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the drug known as Xarelto or Rivaroxaban

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  • the drug known as Xarelto or Rivaroxaban

    Mother just had heart surgery and is being put on this drug and told she has to pump and dump for 24 hours. Could not find any information on the validity of this recommendation. Infant is 2 months old. Thank you.
    Shannon Payne, IBCLC

  • #2
    Dear Shannon,

    Rivaroxaban is a Factor Xa inhibitor preventing deep vein thrombosis. We do not have data on this drug, but it has been assigned a L4 lactation rating. Due to the risk of hemorrhagic complications in the breastfeeding infant, this drug should only be used in lactation if the potential benefit to the mother outweighs the risk to the infant. The T max is 2 to 4 hours, T 1/2 is 5 to 9 hrs with 66 to 100 percent oral bioavailability. The typical dose is 10 to 20 mg once daily by mouth. Her physician may want to consider enoxaparin, heparin or warfarin. Those medications are all compatible with breastfeeding. Hope this information helps.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center
    Last edited by cpride; 03-09-2012, 10:33 AM.

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    • #3
      I am nursing a toddler and have minimal (but some) milk. He nurses for a few minutes 1-2 times per day. I am shifting from coumadin to Xarelto because I had a bleed on coumadin due to severe instability of dosing. (My INR has wavered between 1.8 and 4 since I started the medicine several weeks ago, at 3.6 I started peeing blood.) I'm trying to figure out how much risk there is to him of getting small amounts of milk while I am on this drug. It takes me 10 minutes or so to manually express a few drops at this stage (I had to take Bentyl a few weeks ago, between that and several 24 hour breaks from nursing, multiple hospital visits, etc... I just don't have much milk). He's almost 2 1/2 and nurses primarily for comfort. I'd just as soon not wean him if I don't have to. Just trying to get a sense of risk level. I need to be anticoagulated for the rest of my life and lovenox is not something I can sustain long term--EDS means I have very few good injection spots, and a bruised belly is not highly compatible to parenting a toddler.

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      • #4
        Jenrose:

        As you milk volume is so low, I would not worry about the possible amount in a few drops of milk at this point. At this point we have no data on this drug. If you milk is as low as you suggest, I think the risk is low.

        Tom Hale Ph.D.

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        • #5
          I am flying to Mexico over the holidays for a week, with two 4-hour legs. I suffered a stroke of unknown cause in March of 2013 (I am fine now), and my neurologist has just suggested I think about taking one Xarelto 15 mg just on the mornings of my flights. I currently take an 81mg aspirin every day. I am flying on three different days, none consecutive. I am nursing pretty extensively right now with my one-year-old boy, and I'm wondering, if I take the drug, how long would I need to "pump and dump"? My baby will be flying for the first time, and am nervous he will be miserable, or that I will accidentally wean him, so I am weighing this against the safety of not taking the drug (I also have a PFO hole in the heart.). How long would I have to refrain from nursing after taking the drug for the baby to be safe, would you say? I mentioned Lovenox as an alternative, but that worries my neurologist because of the long acting blood-thinning properties--I have no clotting factor issues, and they never found the clot after the stroke except in the brain. Can you suggest possible alternatives that are safer for baby that I can ask my doctor about? Xarelto was suggested as an extra flying precaution, but not mandatory. A full-strength aspirin was also suggested by my neurologist if I don't take Xarelto, but it's probably not as effective. With the 325mg aspirin, would I need to delay nursing at all, or should I wait 3-4 hours?

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          • #6
            Hi, thanks for your post.

            As we said before, we don't have any data on how much rivaroxiban gets into the milk. It's hard to strike a good balance between the benefits of breastfeeding and the risks of the medication without that information. Toddlers get much less milk relative to their body weights than infants, so the risk in your situation is lower than normal. Interrupting breastfeeding for 12 hours will reduce the amount of this drug in your milk by 60-75%, although this is probably overkill. Watch your child for new bruising or rashes, and do what you can to prevent falls and other minor traumas for a day or so. You do not need to pump and dump, but if you need to pump to avoid engorgement or maintain supply, you should discard that milk. We recommend no breastfeeding interruption for Lovenox and only 2 hours for all doses of aspirin.

            Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

            -James Abbey, MD
            Last edited by admin-james; 01-20-2015, 01:43 PM. Reason: typo

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