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Anti arthritis drugs and breast feeding

Are anti–arthritis drugs safe during lactation?

* Sulphasalazine—sulphasalzine can be taken during nursing. However, a case of bloody diarrhea has been reported in a baby while the mother was on sulphasalazine.

* Methotrexate—Methotreaxte is not safe during lactation.

* Leflunomide—Leflunomide is not safe during lactation.

* Hydroxychloroquine—Hydroxychloroquine is found in the breast milk in very minor quantity. The baby may be exposed to about 2% of the maternal dose. Most experts therefore, continue hydroxychloroquine during nursing.

* Prednisone—may be taken in small doses. Less than 5% of the maternal dose of Prednisosne reach the breast milk. Studies have shown that levels in milk are less than 0.1% of the total dose taken by the mother & this is less than 10% of the steroids produced by the infant's own self. To minimise the risk & if the dose of Prednisone is higher than 20 mg, it is better to pump & discard the breast milk till 4 hours following the oral dose.

* NSAIDs—may be used during nursing. However, they do have a small risk of causing jaundice in the newborn. American Academy of Pediatrics (AAP) considers ibuprofen, indomethacin, diclofenac, naproxen, piroxicam, ketorolac and tolmetin to be compatible with breastfeeding.

* TNF—alpha blockers (Remicade/ Enbrel): There is not much data regarding the safety of these agents during breast feeding. Hence, brest feeding should probable be avoided while on these drugs. Infliximab is a large protein molecule, making it unlikely to be present in significant amount in the breast milk. Additionally, it is not well absorbed from the gut. Thus it is unlikely to affect the breast fed child. However, no conclusive data is presently available in this regard.

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Also Read:
Pregnancy with Rheumatoid Arthritis
Which of the anti–arthritis drugs are safe in pregnancy?
Do anti–arhritis drugs affect fertility?

Created on: April 2007
Last updated on: Feb 2015
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