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

Leflunomide

July 31, 2018 (Very High Risk)

An immunosuppressant with antiproliferative properties used as a disease-modifying antirheumatic drug (DMARD) in rheumatoid arthritis, psoriatic arthritis and in some neoplasms. Its main active metabolite is teriflunomide. Oral administration once or twice a day for months.

Since the last update we have not found published data on its excretion in breastmilk.

Its high binding to plasma proteins makes its transfer to milk in significant concentrations unlikely.

Its slow elimination (half-life of 15 days) and its potentially serious side effects means it is recommended that, until there is more published data on this drug in relation to breastfeeding, safer alternatives are used (Götestam 2016, Flint 2016, Samaritano 2014, Weber 2008, Østensen 2006, Temprano 2005), especially during the neonatal period and in case of prematurity.


See below the information of this related product:

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

  • Λεφλουνομίδη (Greek)
  • ليفلونوميد (Arabic)
  • Лефлуномид (Cyrillic)
  • 来氟米特 (Chinese)
  • レフルノミド (Japanese)
  • C12 H9 F3 N2 O2 (Molecular formula)
  • α,α,α-Trifluoro-5-methyl-4-isoxazolecarboxy-p-toluidide (Chemical name)
  • L04AA13 (ATC Code/s)

Drug trade names

References

  1. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016Abstract Full text (link to original source) Full text (in our servers)
  2. Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016Abstract Full text (link to original source) Full text (in our servers)
  3. Sammaritano LR, Bermas BL. Rheumatoid arthritis medications and lactation. Curr Opin Rheumatol. 2014Abstract
  4. Weber JC, Kuhnert C. Traitements de fond des affections inflammatoires systémiques au cours de l’allaitement. [Breastfeeding and drug management in connective tissue and rheumatic diseases]. Rev Med Interne. 2008Abstract
  5. Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, Doria A, Rai R, Meroni P, Cetin I, Derksen R, Branch W, Motta M, Gordon C, Ruiz-Irastorza G, Spinillo A, Friedman D, Cimaz R, Czeizel A, Piette JC, Cervera R, Levy RA, et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006Abstract Full text (link to original source) Full text (in our servers)
  6. Temprano KK, Bandlamudi R, Moore TL. Antirheumatic drugs in pregnancy and lactation. Semin Arthritis Rheum. 2005Abstract