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

Infliximab

June 25, 2018 (Very Low Risk)

IgG1 monoclonal-antibody against tumor necrosis alpha factor (TNFα) which is used to treat autoimmune diseases such as Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and psoriasis.
Intravenous administration, initial dose, at 2 and 6 weeks and every 8 weeks

As a matter of fact, because of a very high molecular weight and high plasma protein-binding capacity, it is excreted into breastmilk in an undetectable amount (Mahadevan 2005, Vasiliauskas 2006, Stengel 2008, Kane 2009) or clinically non-significant (Ben-Horn 2011, Fritzsche 2012, Grosen 2014 , Matro 2015).

Plasma levels of infants breastfed by mothers who were treated with Infliximab have resulted to be undetectable or very low (Vasiliauskas 2006, Kane 2009, Fritzsche 2012, Steenholdt 2012).

Neither short nor long-term adverse effects on development, immunological response and/or infection rate, nor altered response to vaccination of infants whose mothers were taking Infliximab have been observed (Mahadevan 2005, Vasiliauskas 2006, Stengel 2008, Kane 2009, Tursi 2010, Puig 2010, Correia 2010 , Fritzsche 2012, Steenholdt 2012).

Because it lacks of oral bioavailability, seems difficult any pass to the infant’s plasma through the ingested breastmilk, except on premature infants and immediate neonatal period, in which there may be an increased intestinal permeability.

Numerous experts and scientific societies of Rheumatology, Gastroenterology and Dermatology consider it to be a very low risk drug, and therefore, compatible while breastfeeding (Mahadevan 2011, Nielsen 2014, Hyrich 2014, Mahadevan 2015, van der Houde 2015, Nguyen 2016, Flint 2016 , Gotestam 2016, Briggs 2017).

Alternatives

We do not have alternatives for Infliximab 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

  • cA2
  • CenTNF

Writings

  • Ινφλιξιμάμπη (Greek)
  • إينفليكسيماب (Arabic)
  • Инфликсимаб (Cyrillic)
  • 英利昔单抗 (Chinese)
  • インフリキシマブ (Japanese)
  • C6428 H9912 N1694 O1987 S46 (Molecular formula)
  • Immunoglobulin G (human-mouse monoclonal cA2 heavy chain anti-human tumor necrosis factor), disulfide with human-mouse monoclonal cA2 light chain, dimer (Chemical name)
  • L04AB02 (ATC Code/s)

Drug trade names

References

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