In the summer of 2005, I met several MS patients who were undergoing Solumedrol treatments. I was in the infusion clinic for a release as were several other patients. One patient (I’ll call her Mary), however, was there for a different reason. She had just had a baby.
Before the baby was born, Mary had a plan. She had gone off of her disease-modifying drug (Rebif) when she learned she was pregnant and she planned to breastfeed for a certain period of time before going back on Rebif. The Solumedrol treatment was to ward off any postpartum MS rebounds.
The decision to breastfeed was an important one to Mary as she felt that it was vital to the well-being of her new daughter. But how did Mary decide what drugs to take or not take during that time period?
This week is World Breastfeeding Week and thanks to the LactMed database, offered by the National Library of Medicine, we can research the effect of different drugs and chemicals on lactation.
LactMed is “A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.”
Searching the LactMed database is easy and the information is presented in clear language. All data comes from scientific literature and is fully referenced. Statements regarding a drug’s compatibility with breastfeeding are provided by the American Academy of Pediatrics (AAP).
A new feature for the database is the LactMed App for iPhone and Android mobile devices. The app presents the very same information which is available on the website, including hot links to supporting reference materials. The app was very easy to use and is the source of the information shared below. This information is not intended to be complete nor provide medical advice. It is only a sampling of what is shared in LactMed. Please discuss options with your doctor.
Medications Used in MS and Their Effect on Breastfeeding
In searching the MS disease-modifying drugs, I found a common theme. For Avonex and Rebif (interferon beta-1a), Betaseron and Extavia (interferon beta-1b), and Copaxone (glatiramer acetate) - No data is available, however any amount of the drug found in breastmilk is thought to be very low and is probably destroyed in the infant’s gastrointestinal track. For Tysabri (natalizumab) - No data is available. For Gilenya (fingolimod) - No data is available; an alternate drug may be preferred, especially while nursing a newborn or preterm infant. For Novantrone (mitoxantrone) - Most sources consider breastfeeding to be contraindicated.
For treatment of exacerbations, limited information is available for Solumedrol (methylprednisolone). With high doses (especially intravenous doses), avoid breastfeeding for 3-4 hours after dose to decrease the dose received by the infant. No information is available regarding Decadron (dexamethasone), so an alternate drug may be preferred. Limited information regarding Deltasone (prednisone) indicates that low doses up to 20mg produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants. With high doses, the use of prednisolone (instead of prednisone) and waiting to breastfeed until 3-4 hours should decrease the dose received by the infant. H.P. Acthar Gel (adrenocorticotropic hormone, ACTH) - Not listed in LactMed.
