© Springer International Publishing Switzerland 2015
Daniel J. Stein and Reza Shaker (eds.)Inflammatory Bowel Disease10.1007/978-3-319-14072-8_2424. Is It Safe for Me to Breastfeed While on My IBD Medications? Safety of Lactation and IBD Medications
(1)
Departments of Gastroenterology, Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, TN, USA
(2)
Department of Hepatology and Nutrition, Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, TN, USA
(3)
Departments of Gastroenterology, Inflammatory Bowel Disease Center, Nashville, TN, USA
(4)
Department of Hepatology and Nutrition, Inflammatory Bowel Disease Center, Nashville, TN, USA
Suggested Response to the Patient
Most medications used to treat inflammatory bowel diseases (IBDs) including ulcerative colitis and Crohn’s disease are safe to continue while breastfeeding. Medications including 5-aminosalicylic acids (5-ASAs), thiopurines, and anti-tumor necrosis factor medications are excreted in minimal concentrations in breast milk and cause little to no known adverse side effects in the breastfed infant. An important exception to this rule is methotrexate, which is pregnancy category X and should not be used in pregnant or breastfeeding mothers. Also, several antibiotics sometimes used in the treatment of IBD, including metronidazole and ciprofloxacin, can be excreted into the breast milk, and long-term use should be avoided if possible. Additionally, some experts recommend that lactating mothers withhold breastfeeding for 4 h after taking a dose of a thiopurine agent (azathioprine or 6-mercaptopurine) to help decrease infant exposure to this medication, although long-term studies on this medication have failed to show any increased risk of infections in breastfed infants of mothers taking azathioprine. Anti-tumor necrosis factor agents (infliximab, adalimumab, and certolizumab) have little to no excretion in breast milk and are likely compatible with breastfeeding. Finally, although there is little data available on the safety of breastfeeding with anti-integrin antibody agents (natalizumab, vedolizumab), they may be detected in breast milk and caution should be used when administering to nursing women.
Brief Review of the Literature
5-Aminosalicylate Acid Medications
5-Aminosalicylate (5-ASA) medications and their metabolites pass into breast milk at relatively low concentrations (30–50 % of maternal plasma concentrations) and are generally considered safe in breastfeeding moms [1]. There are rare reports of diarrhea in breastfed infants of mothers taking 5-ASA medications. Therefore, the infant should be monitored for such symptoms with consideration of discontinuing the medication if these symptoms persist in the infant [2, 3].
Antibiotics
Metronidazole is excreted in breast milk and is generally not recommended for long-term use in breastfeeding mothers. If a single dose is given, the American Academy of Pediatrics recommends waiting 12–24 h before breastfeeding [4].
Very small quantities of ciprofloxacin are excreted into breast milk; however, given the concern for potential arthropathies in children, the Summary of Product Characteristics recommends that mothers wait 48 h before breastfeeding after a single dose [5].
Given the limited evidence to support antibiotic use for the treatment of IBD and the need for an extended course of therapy if used, antibiotics should generally be avoided in breastfeeding mothers [6]. Short courses of ciprofloxacin and/or metronidazole can be considered for the treatment of pouchitis, or alternatively, a different antibiotic, such as amoxicillin/clavulanic acid (pregnancy category B), can be considered.
Glucocorticoids
Glucocorticoids are considered safe in breastfeeding due to low levels of excretion in breast milk [7]. Safety of budesonide in lactation is not known.
Immunomodulators
Methotrexate is pregnancy category X. It is excreted in breast milk and is contraindicated in breastfeeding mothers [4]. Possible adverse effects to the infant include immunosuppression, neutropenia, and possible link to carcinogenesis [8].
Thiopurine agents including azathioprine and 6-mercaptopurine have been detected in the breast milk of lactating mothers at negligible levels ranging from 2 to 50 μg/L with peak concentrations within 3–4 h after taking a dose [9]. These levels are far less than the infant’s maximum risk-free ingestion amount of <0.008 mg/kg/day, and no studies have found detectable levels of thiopurines in the serum of breastfed infants [10]. One case-control study investigating long-term effects did not reveal any increased risk of infections in breastfed infants of mothers taking azathioprine [11]. There are no strong contraindications to breastfeeding while on azathioprine or 6-mercaptopurine, but some experts recommend that lactating mothers could be advised to wait to breastfeed for at least 4 h after taking a dose.
Related posts:
What Factors of My Crohn’s Disease Put Me at Higher Risk of Complications? Identifying Crohn’s Patients with Severe Disease
Why Did This Happen to Me? Epidemiology, Genetics, and Pathophysiology of IBD
What Is the Best Possible Therapy for My Crohn’s Disease? State-of-the-Art Therapy for Newly Diagnosed Crohn’s Disease
Why Do I Need to Have Surgery for My Crohn’s Disease? Surgical Management of Crohn’s Disease
What Is Life Like After Colectomy for UC? Ileal Pouch-Anal Anastomosis and Pouchitis
Does Stress Play a Role in My Disease? The Role of Stress and Psychiatric Issues in IBD
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