Humira and Asacol

[Lawanda287]

I am a IBCLC working in a community hospital. I was contacted by a pediatrian about a pregnant patient who really wants to breastfeed. She is 32 years old and was diagnosed with colitis in 1999. She currently is on Humira 40 mg injections every 2 weeks since 2007. She also takes Asacol 800 mg tablets--6 tablets QD since about 2000. These are the only medications that were able to put her in remission. She is 32-33 weeks pregnant currently. What is Dr. Hales recommendations regarding if she will be able to breastfeed?

[cpride]

Dear Lawanda287,

Both of these medications are compatible with breastfeeding. We do not have data on how much Humira enters breastmilk. Dr. Hale states that IgG transfers into breastmilk poorly, and medications such as Humira are IgG1 analogs. These IgG1 analogs are even less likely to transfer into breastmilk based on their kinetic profile. If the mother would prefer a medication we have data on, infliximab (Remicade) would be an option she may talk with her physician about. The relative infant dose (RID) is 0.3 percent of maternal dose and is considered a L2. Mesalamine (Asacol) contains 5-aminosalicylic acid (5-ASA) and acteyl-5-ASA is its metabolite. Mesalamine's relative infant dose varies from 0.1 percent to 8.8 percent of maternal dose. The medication has low oral absorption (20 to 30 percent) which decreases the risk to the infant. The dose this mother is taking is high (usual dose is 2400 mg daily), and there is some concern that at higher doses the salicylic acid could become significant (salicylic acid is aspirin). Aspirin increases the risk of Reyes syndrome if the child becomes ill with a viral illness. The infant should be observed for watery diarrhea. Mesalamine may be administered rectally and is poorly absorbed systemically. Since, plasma levels are exceedingly low (<=2 µg/mL) following rectal administration, breastmilk levels would be quite low as well. This mother may talk with her physician to see if she would be a candidate for rectal administration for part of her dose to decrease the amount of mesalamine entering breastmilk if the infant has watery diarrhea or if this mother is concerned about the increased risk of Reyes syndrome. This mother may call us also if she has further questions. The InfantRisk Center is open Monday through Friday, 8 to 5, CDT. The phone number is 806-352-2519.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center