Hi, thanks for your post.
Yes, actually there is new information on this topic. I don't get a chance to say that very often. A new case study (cited below) showed no change in levels of VEGFA in the milk after intraocular treatment with ranibizumab. VEGFA is the molecule that ranibizumab is designed to destroy. The study authors did not measure drug levels directly. Prescribing information published by the manufacturer describes animal studies on this drug which showed that systemic exposure of ranibizumab was more than 2000-fold lower than in the vitreous humor. The drug's large molecular weight drastically reduces the amount of systemic drug that would cross into the milk, although I have not seen specific numbers described anywhere for this product. The bottom line is that we do not expect the degree of exposure via breastmilk to be clinically relevant to the baby.
For anyone reading this, please post again or call us at the InfantRisk Center, (806)352-2519, if this has not completely answered your question. I would also appreciate you filling out a 2 minute survey about your time on the forum:
https://tthsclubbock.co1.qualtrics.com/SE/?SID=SV_bJzhyKVSivVkQZL&Counselor=Web
-James Abbey, MD
Ehlken C, Martin G, Stahl A, Agostini HT. Reduction of vascular endothelial growth factor a in human breast milk after intravitreal injection of bevacizumab but not ranibizumab. Arch Ophthalmol. 2012 Sep;130(9):1226-7. PMID: 22965611.
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Ranibizumab intraocular
A 35 yrs old breastfeeding mother of a 22 month old baby needs therapy with intraocular ranibizumab. In your 2008 edition book I found that it is L3 and unlikely to pose a threat to a breastfeeding baby since it has a large molecular weight. Do you have some more information on this?
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