Re: RA, medication and breastfeeding

[Guest guest]

Welcome, Jennie! Sorry about your RA diagnosis. I understand your

dilemma about the drugs and your commitment to breastfeeding.

Here's an excerpt from a recent Q & A from the Hospital for Special

Surgery rheumatology Web site:

" Therapy with anti-TNF agents during breast-feeding is not recommended,

although little data is available. A single case report suggests that

infliximab is not excreted in breast milk. It is not known if etanercept

or adalimumab are excreted in human milk or absorbed systemically after

ingestion. Given the known immunosuppressive effects of these

medications, the unknown risk of transfer to the neonate, and the

available alternative of infant formula, avoidance of breastfeeding

while taking TNF-alpha inhibitors seems logical. "

http://www.rheumatology.hss.edu/phys/askExpert/answers/019.asp

This is another selection from the same site from an article entitled,

" Pregnancy in Autoimmune and Musculoskeletal Disease " :

" A. Paget, MD: What about in the post-partum state, when the

woman is nursing -- and obviously some women nurse for a shorter period

of time and others longer -- relative to transferring antibodies and

protection. What do you usually recommend there as far as the

reinstitution of medicines?

Sammaritano, MD: Well, again, it depends on the patient and on the

medication. Steroids are considered -- again low-dose is optimal -- safe

for women who are breast-feeding. Anti-inflammatories are in the middle,

and we usually recommend ibuprofen and try to time the breast feeding

about four hours after taking the medication to minimize the amount of

ibuprofen in the breast milk. Other medications are considered

relatively safe, for example, heparin in patients who need to be on that

for some weeks post-partum. Interestingly, for patients who have

problems with blood clotting during pregnancy who don't take warfarin

(Coumadin) during the pregnancy, Coumadin is actually considered okay

for women who are breast-feeding because it really doesn't go into the

breast milk to any significant degree. So you have to decide how great

the risk of increased disease activity is, how great a desire the

patient has to breast feed, and then try to balance things between that.

Generally hydroxychloroquine and gold salts, people don't like to have

their patients breast feeding on those medications, but if the patient

insists sometimes you try to work out a compromise. "

http://www.rheumatology.hss.edu/phys/interviews/sammaritano_int_tran.asp

I wish you luck!

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] RA, medication and breastfeeding

> I have RA and was just diagnosed this year. I have one daughter who

is 3/12 and who I breastfed for 23 months. I am probably a few years

away from having another child, but breastfeeding is very important to

me and I want to do it if there is a good indication that it is safe.

Everything I read says no breastfeeding once the RA returns post-partum

(assuming you have a remission during pregnancy). But there is a post

on here of someone taking Enbrel while breastfeeding and I have seen a

couple references to studies but cannot find any results of those

studies. Does anyone know if you can take prednisone while

breastfeeding? Any information on studies of Enbrel/Remicade/Humira? I

am currently taking prednisone and methotrexate, and I start Humira

today. Thank you.

>

> Jennie