Nursing and RA meds

[Guest guest]

" 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. "

Hospital for Special Surgery

January 30, 2002

" Pregnancy in Autoimmune and Musculoskeletal Disease " :

http://www.hss.edu/Professionals/Conditions/Autoimmune-Diseases/Autoimmune-Pregn\

ancy

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org