Gadovist (Gadobutrol) for MRI

[admin]

Jburrell:

MRI scans use a gadolinium contrast agent. They enter breastmilk only minimally, generally less than 0.023% of the dose and virtually none of this is orally absorbed by an infant ( < 0.8%). My advice is to pump and discard milk at 2 hour or so after the procedure and go back to breastfeeding thereafter. The American College of Radiology now suggests that mothers do not have to discontinue breastfeeding following the use of radio contrast agents.

Tom Hale Ph.d.
Infantrisk Center

[jburrell]

Hello - I am having a breast MRI in 5 days and am also being told to pump and dump. My son is 6 months old - Is there an increased risk with infants vs toddlers? If I need to dump, how long after? Thank you.

[admin-james]

Hi, thanks for your post.

It is my opinion that gadobutrol should not require breastfeeding cessation in your case. The gadolinium contrast agents are meant to stay in the bloodstream, not to leak out into other areas (like the milk) that could ruin the scan. The manufacturer says that similar compounds show up in the milk in the range of 0.01% to 0.04% of the maternal dose. We also expect it to have limited oral absorption in your baby. Furthermore, toddlers get much less milk relative to their body weights than infants, so that cuts the numbers down even further.

There have been no cases of NSF associated with Gadavist or any other gadolinium-based contrast agent in patients < 6 years who received it directly. The patients at the highest risk of developing problems are those with chronic, severe kidney disease or a significant kidney injury. Kidney function in a healthy 2 1/2 year old should be close to an adult's.

If you are looking for a compromise between my position and that of your doctor, consider just pumping and dumping once when you get home from the procedure. Although still very small, the levels in your milk will be highest at that time.

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

-James Abbey, MD

[AgH]

MRI scan of my head with the usual dose of 7m (mg?) Gadovist (Gadobutrol) as contrast is planned. The Irish drug safety newsletter from February 2010 evaluates the risk of Nephrogenic Systemic Fibrosis (NSF) and recommends suspending breastfeeding for 24 hours at the consultant's discretion in consultation with the mother. My consultant thinks suspending breastfeeding for 24 hours is easy with a 2-and-a-half-year-old and therefore that's what I should do. However I know (from my experience of much shorter periods of time where breastfeeding had to be postponed) that it means a lot of tears and crying and nobody getting any sleep. What is your advice on how long to postpone breastfeeding, and should I pump and dump, too?