Breast feeding okay for mothers taking immunosuppressant drug

Only minor levels of the drug are transferred to infants through breast milk

2013-01-25

(Press-News.org) Highlights The breast milk of mothers taking the immunosuppressant tacrolimus contains only very low levels of the drug. Women taking tacrolimus who wish to breast-feed after appropriate counseling should not be discouraged from doing so.

Increasing numbers of pregnant women are taking tacrolimus after organ transplantation and for other conditions.

Washington, DC (January 24, 2013) — Women taking the immunosuppressant tacrolimus can rest assured that breast feeding will not elevate their babies' exposure to the drug, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings are good news for young women who have received an organ transplant in the past or who are taking the drug for other reasons.

Women taking the tacrolimus have previously been advised not to breast feed due to the possibility that the drug might be transferred to the baby, which could potentially suppress the baby's developing immune system. While there are many benefits to breast-feeding, there is very little known about the safety of breast-feeding while taking tacrolimus.

Kate Bramham, MRCP (King's College London) and her colleagues looked to determine the extent to which tacrolimus is transferred to infants via breast milk. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants (11 of whom were exclusively breast-fed) were assessed.

Among the major findings: Babies born to mothers taking tacrolimus had high levels of the drug in their blood at birth, likely due to transfer across the placenta, but the levels fell as the liver cleared the drug. Both babies who were breast-fed and those who were bottle-fed cleared the drug at the same rate. Most cleared the drug by two weeks. The breast milk of mothers taking tacrolimus contained only very low levels of the drug. (If babies were to take the same amount of tacrolimus per kilogram of body weight as their mothers, they would need to consume approximately 150 liters of breast milk per day.)

"Our study shows that levels of the drug are not significantly increased through breast feeding. Although more studies are needed on the safety of tacrolimus, the findings would suggest that women who wish to breastfeed should not be discouraged from doing so," said Dr. Bramham. "The advantages, particularly in preterm infants, need to be weighed against the theoretical disadvantages of minimal ingestion through breast milk," she added. Of note, women who have received a kidney transplant in the past are more likely to have early deliveries.

### Study co-authors include Gary Chusney, Janet Lee PhD, Liz Lightstone, PhD, FRCP, and Catherine Nelson-Piercy, FRCP, FRCOG.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Breast-feeding and Tacrolimus: Serial Monitoring in Breast and Bottlefed Infants," will appear online at http://cjasn.asnjournals.org/ on January 24, 2013, doi: 10.2215/CJN.06400612.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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Breast feeding okay for mothers taking immunosuppressant drug

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