Use Of Drugs During Breast Feeding

Some drugs are secreted in breast milk. They are not required for the baby and may be harmful. The quantity of most drugs excreted in breast milk is less than 10% of the therapeutic dose in children. As a general rule breast feeding should not be done for 2 hours after taking a drug. 90% of patients with rheumatoid and other inflammatory arthritis suffer a disease flare within 3 months of delivery. It may be prudent to stop feeding child early, in case of need to start contraindicated drugs for patients with nonresponsive arthritis. It must be kept in mind that optimal disease control is essential for prevention of deformities. A disabled mother due to deformed joints will certainly be unable to bring up her child well.

Recommendations on use of drugs during breast feeding are given in following table.

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 DrugRemark
1ParacetamolSafe. Feed after 2 hours.
2Anti-inflammatory PainkillersSafe/no substantial information. Ibuprofen, Indomethacin, Diclofenac, Naproxen are compatible. Ibuprofen is best choice.
3SteroidsNo adverse effects on children upto 10 mg/day. Glucocorticoids, Prednisone preferred. Less than 0.1%excreted in milk.
4HydroxychloroquinSafe.2% of dose excreted in milk.
5SulphasalazineSafe. Caution in premature babies and in infantile jaundice.
6MethotrexateNo reported risk.0.02% dose ingested by child. Do not feed for 9 hours after tablet. Monitor the child.
7LeflunomideNo data about secretion in milk. Avoid if possible.
8AzathioprineSafe. Almost undetectable in milk. No evidence of adverse effects in infants. Monitor the child.
9CyclophosphamideNo data. Avoid if possible.
10MycophenolateAvoid.
11Biologic drugsInsufficient data. Small amounts in breast milk. Avoid if possible.
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