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6G Mercaptopourine

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  • 6G Mercaptopourine

    good morning,
    my client is currently taking 75g of 6G Mercaptopourine for her chrons.
    I believe she has had the dose halved during pregnancy and was instructed not to breastfeed in her last pregnancy whilst medicated.
    You have identifed this as an L3 category-
    can you recommend a safe alternative

  • #2
    Dear leadman,

    Mercaptopurine is the metabolite of azathioprine. We know that only minimal amounts of azathioprine enter breastmilk. Since this is a strong immunosuppressant, Dr. Hale recommends for the infant to be monitored periodically for immunosuppression and hepatotoxicity, This can be done by simple blood tests. This medication is compatible with breastfeeding. Recent long term data suggests that the rate of infections in treated groups is no different from non-treated controls.
    If the mother prefers a L2 medication, then the alternative that Dr. Hale suggests is infliximab (Remicade). Infliximab is a very large molecular weight antibody and is largely retained in the vascular system. It is highly unlikely that infliximab would enter breastmilk in significant quantities. Reported studies of infliximab use during breastfeeding have revealed that little to none enters breastmilk. Levels in milk are 1/200th of the levels in maternal serum. Further, infliximab is not orally bioavailable. Any miniscule amounts ingested by the infant through breastmilk will undergo proteolysis in the infant's gastrointestinal tract, thereby having minimal impact on the immune system of the infant.
    Other choices that the mother may talk with her physician about are adalimumab (Humira), short term treatment with prednisone and low dose once weekly methotrexate treatments are compatible with breastfeeding but require some pumping and discarding time. After the mother consults with her physician about these options, have her call us at the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CDT. We can give her specifics on how long to pump and discard with each of these options.

    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center