Is Calcipotriol compatible with breastfeeding? Do we have alternatives for Calcipotriol?

Calcipotriol

January 29, 2017 (Very Low Risk)

Synthetic drug analog to vitamin D3 which is similar to calcitriol.
It is topically used on the treatment of psoriasis.

At latest update relevant published data on excretion into breast milk were not found.

Due to a poor gut absorption, plasma levels were undetectable or very low (AEMPS 2014), so it is unlikely a passage in significant amounts into breastmilk.
In addition, it is a derivative of vitamin D3 with poor effect on calcium metabolism. No significant changes on calcium plasma levels have been observed, whenever compliance with the maximum recommended doses is followed (Murdoch 1992, Bourke 1993 and 1997, Blum 1998).

Therefore, several consensus of experts accept the use of Calcipotriol as safe while breastfeeding (Zip 2002, Leachman 2006, Strober 2009, Barrett 2013, Butler 2014) which can even be applied to the nipple whenever necessary (Barrett 2013 ).
It can be applied for long time periods during breastfeeding provided it would not cover more than 20% of body surface area (Barrett 2013).

It should be avoided application on the nipple of creams, gels and other topical containing-paraffin products (mineral oil) so that the infant would not absorb them (Noti 2003, Concin 2008).
In case of psoriasis of the nipple it should be applied after a feeding at breast followed by a thoroughly cleaning up with water before the next feeding.

Alternatives

We do not have alternatives for Calcipotriol since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Calcipotriene

Writings

  • Καλκιποτριόλη (Greek)
  • كالسيبوتريول (Arabic)
  • Кальципотриол (Cyrillic)
  • 卡泊三醇 (Chinese)
  • カルシポトリオール (Japanese)
  • C27H40O3 (Molecular formula)
  • MC-903 (Experimental code/s)

Drug trade names

References

  1. Leo. Calcipotriene (Dovonex). Drug Summary. 2015 Full text (in our servers)
  2. AEMPS. Calcipotriol-Betametasona (Daivobet). Ficha técnica. 2014 Full text (in our servers)
  3. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014Abstract
  4. Barrett ME, Heller MM, Fullerton Stone H, Murase JE. Dermatoses of the breast in lactation. Dermatol Ther. 2013Abstract
  5. Leo. Calcipotriol & Betamethasone (Dovobet). Product Monograph. 2011 Full text (in our servers)
  6. Strober B, Berger E, Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb A, Horn EJ, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Menter A, Schwartzman S, Sobell JM, Young M. A series of critically challenging case scenarios in moderate to severe psoriasis: a Delphi consensus approach. J Am Acad Dermatol. 2009Abstract
  7. Concin N, Hofstetter G, Plattner B, Tomovski C, Fiselier K, Gerritzen K, Fessler S, Windbichler G, Zeimet A, Ulmer H, Siegl H, Rieger K, Concin H, Grob K. Mineral oil paraffins in human body fat and milk. Food Chem Toxicol. 2008Abstract
  8. AEMPS. Calcipotriol (Daivonex). Ficha técnica. 2007 Full text (in our servers)
  9. Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006Abstract
  10. Noti A, Grob K, Biedermann M, Deiss U, Brüschweiler BJ. Exposure of babies to C15-C45 mineral paraffins from human milk and breast salves. Regul Toxicol Pharmacol. 2003Abstract
  11. Zip C. Common sense dermatological drug suggestions for women who are breast-feeding. Skin Therapy Lett. 2002Abstract
  12. Blum R, Schwartzel E, Siskin S, Epinette WW. Evaluating the safety of calcipotriene 30 g per day in patients with psoriasis: a parallel group, vehicle-controlled study. J Clin Pharmacol. 1998Abstract
  13. Bourke JF, Berth-Jones J, Mumford R, Iqbal SJ, Hutchinson PE. High dose topical calcipotriol consistently reduces serum parathyroid hormone levels. Clin Endocrinol (Oxf). 1994Abstract
  14. Bourke JF, Berth-Jones J, Iqbal SJ, Hutchinson PE. High-dose topical calcipotriol in the treatment of extensive psoriasis vulgaris. Br J Dermatol. 1993Abstract
  15. Murdoch D, Clissold SP. Calcipotriol. A review of its pharmacological properties and therapeutic use in psoriasis vulgaris. Drugs. 1992Abstract