Arcoxia and Breastfeeding

[Lactation Clinic]

Dear Dr. Hale,
I have reviewed all topics related to Arcoxia in the InfantRisk Forum for several years because I cannot find this medication in "Medications and Mothers' Milk."
Only this channel can help me. I understand this medication is not available in the USA.
One answer mentioned the age of an infant at 9 months.
The use of Arcoxia has become popular in private hospitals. Please suggest, when the mothers can start to use Arcoxia safely.
Thank you so much for your kind help as always.

[kaytlin]

Lactation Clinic:

We understand your struggle, there is very little data to go off of. I have reviewed the literature again and there is nothing new to report. I understand many hospitals are trying opioid-free regimens, which often include COX-2 inhibitors. Of the COX-2 inhibitors, celecoxib is the only one we have any data on for the transfer to breastmilk (which was very low). For these reasons, celecoxib is our preferred choice of COX-2 inhibitors. Arcoxia has similar properties which lead us to believe it would behave similarly in milk, perhaps to a slightly greater degree. Arcoxia stays in the body twice as long as celecoxib and has less protein binding, both leading to increased levels in the blood and milk.

With all of that in mind, if a mom was to take Arcoxia post-delivery for a few days I would not suspect any trouble breastfeeding a healthy newborn. The issues with COX-2 inhibitors generally develop with chronic use. I would start questioning it for more than a couple of weeks or for an infant with GI or cardiovascular issues, but the risk is probably still low.

If we see an uptick in questions about Arcoxia, we'll include it in the 2023 edition of the book.

Kaytlin Krutsch, PharmD, MBA, BCPS

[Lactation Clinic]

Thank you very much for your valuable suggestion.