Use Of Drugs During Breast Feeding

Some drugs are secreted in breast milk. They are not required for the baby and may be harmful. Most drugs excreted in breast milk are less than 10% of the therapeutic dose in children. As a general rule, breastfeeding should not be done for 3 hours after taking a drug. 90% of patients with rheumatoid and other inflammatory arthritis suffer a disease flare within three months of delivery. It may be prudent to stop feeding the 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 the prevention of deformities. A disabled mother, due to deformed joints, will undoubtedly be unable to bring up her child well.

Recommendations on the use of drugs during breastfeeding are given in the following table.

  Drug Remark
1

Paracetamol

Safe. Feed after 3 hours.
2

Anti-inflammatory Painkillers

Safe/no substantial information. Ibuprofen, Indomethacin, Diclofenac, and Naproxen are compatible. Ibuprofen is the best choice.
3

Steroids

No adverse effects on children up to 10 mg/day. Prednisone preferred, Less than 0.1%excreted in milk
4

Hydroxychloroquin

Safe. 2% of the dose excreted in milk
5

Sulphasalazine

Safe. Caution in premature babies and infantile jaundice.
6

Methotrexate

No reported risk. Less than 10% excreted in milk. Do not feed for 9 hours after tablet. Monitor the child.
7

Leflunomide

Insufficient data about secretion in milk. Avoid if possible.
8

Azathioprine

Safe. Almost undetectable in milk. No evidence of adverse effects in infants. Monitor the child.
9

Cyclophosphamide

No data. Avoid if possible.
10

Mycophenolate

Avoid.
11

Tofacitinib

Excreted in animal milk. Avoid. Not known whether excreted in human milk.
12

Etanercept Infliximab Adalimumab

Minimal excretion in breast milk. Compatible.
13

Rituximab

Insufficient data. Not recommended.
14

Tocilizumab

Insufficient data. Not recommended.
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