Itp

[ITPmom]

I was recently diagnosed with ITP. My hematologist would like to start prednisone at 60-80mg a day for at least 3 months. She said she may be willing to go as low as 40mg first to see if this works. But we also talked about the possibility of taking nplate. Are either of these safe? My daughter is not even 3 months old yet, so the thought of taking any medications really concerns me.

[admin-james]

Hi, thanks for your post.

The basics of steroids are discussed here:
http://mommymeds.com/frequently-asked-questions/steroids

If the baby gets too much corticosteroid, it could interfere with her growth a little. There are no formal studies to guide us on this issue, so we set our informal cutoff at >40mg / day for >2 weeks. We have a ton of case studies describing breastfeeding women taking steroid doses lower than that for long periods of time with no problems. I want to emphasize that this is only our opinion based on pharmacological theory. At prolonged doses of >40mg / day, I advise the following:

1. Attend all routine appointments with your pediatrician and make sure he/she is aware of your steroid use. If your baby is examined every 2 months or so, the doctor's office should be able to spot slowed growth before any real damage is done.

2. You will have the greatest amount of steroid in your milk between 1 and 4 hours after you take your dose. Try to avoid breastfeeding inside this window if possible. If you need to feed during that time, dilute your milk 50:50 with formula or stored milk. These two tricks should cut your baby's steroid exposure by at least 50%.

Nplate (romiplostim) is a synthetic signaling protein that interacts with your bone marrow to stimulate platelet production. Proteins of all kinds are easily digested in the stomach; that's why Nplate has to be injected under your skin. That means that most of the drug that gets to the baby will be destroyed in her stomach. There are no formal studies examining the safety of Nplate in breastfeeding women. Based on the drug's chemical properties, we predict that very little of it will get into the breastmilk in the first place. We give this drug an intermediate safety rating ("probably compatible") because of the lack of hard data.

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

-James Abbey, MD