Is Gadofosveset Trisodium compatible with breastfeeding? Do we have alternatives for Gadofosveset Trisodium?

Gadofosveset Trisodium

November 5, 2015 (Low Risk)

Gadolinium chelate with action and uses similar to those of gadopentetic acid but with a longer half-life.
At the date of last update, we did not find published data on its excretion in breast milk.
During lactation it may be preferable to choose a faster elimination gadolinium contrast, especially during the neonatal period.

The various contrast media derived from gadolinium for Nuclear Magnetic Resonance (NMR) scans are considered compatible with breastfeeding due to rapid elimination (elimination half-life of less than 2 hours) with hardly any metabolism and being practically non-absorbable orally. They are structurally very similar to each other and from some of them there is data of their null or minimal excretion in milk.

Less than 0.04% of the dose administered to the mother ends up in milk.
Due to its poor oral bioavailability, intestinal absorption is less than 1% of the dose that the infant could have taken.
The maximum dose received by the infant is less than 0.0004% of the maternal dose, which is much less than the dose given to an infant or newborn who undergoes MRI.

Most scientific societies of radiology agree that after an MRI scan it is not necessary to wait for any time to breastfeed.

Some authors and societies recommend avoiding high-risk gadolinium contrasts of nephrogenic systemic fibrosis in lactating women, especially in the neonatal period: gadoversetamide, gadodiamide and gadopentate, choosing the low-risk ones: gadoterate, gadoteridol and gadobutrol.

Alternatives

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.

Writings

  • Тринатрий Гадофосвезет (Cyrillic)
  • ガドホスベセット三ナトリウム (Japanese)
  • C33H38GdN3Na3O14P (Molecular formula)

Drug trade names

References

  1. Cova MA, Stacul F, Quaranta R, Guastalla P, Salvatori G, Banderali G, Fonda C, David V, Gregori M, Zuppa AA, Davanzo R. Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy. Eur Radiol. 2014Abstract
  2. Patenaude Y, Pugash D, Lim K, Morin L; Diagnostic Imaging Committee, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Naud K, Ouellet A, Salem S; Society of Obstetricians and Gynaecologists of Canada. The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can. 2014Abstract
  3. Quintana Rodríguez I. Uso de contrastes radiológicos en la mujer lactante y en niños.. CbSERAM nº 8/14 – Agosto 2014Abstract Full text (link to original source) Full text (in our servers)
  4. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013Abstract Full text (link to original source) Full text (in our servers)
  5. Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics. 2012Abstract Full text (link to original source) Full text (in our servers)
  6. Wang PI, Chong ST, Kielar AZ, Kelly AM, Knoepp UD, Mazza MB, Goodsitt MM. Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. AJR Am J Roentgenol. 2012Abstract Full text (link to original source) Full text (in our servers)
  7. EMA. Assessment report for Gadolinium-containing contrast agents. 2010 Full text (in our servers)
  8. Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol. 2008Abstract
  9. Newman J. Breastfeeding and radiologic procedures. Can Fam Physician. 2007Abstract Full text (link to original source) Full text (in our servers)
  10. Lin SP, Brown JJ. MR contrast agents: physical and pharmacologic basics. J Magn Reson Imaging. 2007Abstract
  11. Webb JA, Thomsen HS, Morcos SK; Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005Abstract
  12. Hylton NM. Suspension of breast-feeding following gadopentetate dimeglumine administration. Radiology. 2000Abstract
  13. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, Seifert B, Puchert E, Wittek S, Debatin JF. Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology. 2000Abstract
  14. Rofsky NM, Weinreb JC, Litt AW. Quantitative analysis of gadopentetate dimeglumine excreted in breast milk. J Magn Reson Imaging. 1993Abstract
  15. Schmiedl U, Maravilla KR, Gerlach R, Dowling CA. Excretion of gadopentetate dimeglumine in human breast milk. AJR Am J Roentgenol. 1990Abstract