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

Propylthiouracil

February 23, 2017 (Very Low Risk)

Small amount of Propylthiouracil can reach the breast milk but it doesn't cause harm to the thyroid function (Low 1979, Kampmann 1980, Cooper 1987).

The American Thyroid Association among others (Mandel 2001, Stagnaro 2011, Alexander 2017) stated that a daily dose as high as 450 mg is safe while breastfeeding. However, some studies have shown no harmful effect at a daily dose as high as 750 mg (Kampmann 1980, McDougall 1986, Cooper 1987, Momotani 1989 y 2000, Bartalena 2005, Azizi 2006, Marx 2008, Inoue 2009, Glatstein 2009).

Methimazole or Carbimazole is preferred since liver toxicity has been found among patients who were treated with Propylthiouracil (Karras 2009, 2010 y 2012, Azizi 2011, Serrano 2014, Hudzik 2016).

The American Academy of Pediatrics has rated it (2001) as compatible with breastfeeding.

Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding.

Alternatives

We do not have alternatives for Propylthiouracil 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

  • PTU

Writings

  • προπυλοθειουρακίλη (Greek)
  • بروبيلثيوراسيل (Arabic)
  • Пропилтиоурацил (Cyrillic)
  • 丙硫氧嘧啶 (Chinese)
  • プロピルチオウラシル (Japanese)
  • C7H10N2OS (Molecular formula)

References

  1. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017Abstract Full text (link to original source) Full text (in our servers)
  2. Hudzik B, Zubelewicz-Szkodzinska B. Antithyroid drugs during breastfeeding. Clin Endocrinol (Oxf). 2016Abstract
  3. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015Abstract
  4. Karras S, Krassas GE. Breastfeeding and antithyroid drugs: a view from within. Eur Thyroid J. 2012Abstract Full text (link to original source) Full text (in our servers)
  5. Lazarus JH. Pre-conception counselling in graves' disease. Eur Thyroid J. 2012Abstract Full text (link to original source) Full text (in our servers)
  6. Azizi F, Amouzegar A. Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol. 2011Abstract Full text (link to original source) Full text (in our servers)
  7. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W; American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum.. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011Abstract Full text (link to original source) Full text (in our servers)
  8. Karras S, Tzotzas T, Kaltsas T, Krassas GE. Pharmacological treatment of hyperthyroidism during lactation: review of the literature and novel data. Pediatr Endocrinol Rev. 2010Abstract
  9. Inoue M, Arata N, Koren G, Ito S. Hyperthyroidism during pregnancy. Can Fam Physician. 2009Abstract Full text (link to original source) Full text (in our servers)
  10. Glatstein MM, Garcia-Bournissen F, Giglio N, Finkelstein Y, Koren G. Pharmacologic treatment of hyperthyroidism during lactation. Can Fam Physician. 2009Abstract Full text (link to original source) Full text (in our servers)
  11. Karras S, Tzotzas T, Krassas GE. Antithyroid drugs used in the treatment of hyperthyroidism during breast feeding. An update and new perspectives. Hormones (Athens). 2009Abstract Full text (link to original source) Full text (in our servers)
  12. Fumarola A, Calvanese A, Di Fiore A, Dainelli M, D'Armiento M. [Antithyroid drugs therapy]. Clin Ter. 2009Abstract
  13. Azizi F. Treatment of post-partum thyrotoxicosis. J Endocrinol Invest. 2006Abstract
  14. Clark SM, Saade GR, Snodgrass WR, Hankins GD. Pharmacokinetics and pharmacotherapy of thionamides in pregnancy. Ther Drug Monit. 2006Abstract
  15. Azizi F. The safety and efficacy of antithyroid drugs. Expert Opin Drug Saf. 2006Abstract
  16. Koren G, Soldin O. Therapeutic drug monitoring of antithyroid drugs in pregnancy: the knowledge gaps. Ther Drug Monit. 2006Abstract Full text (link to original source) Full text (in our servers)
  17. Bartalena L, Tanda ML, Bogazzi F, Piantanida E, Lai A, Martino E. An update on the pharmacological management of hyperthyroidism due to Graves' disease. Expert Opin Pharmacother. 2005Abstract Full text (link to original source) Full text (in our servers)
  18. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  19. Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab. 2001Abstract Full text (link to original source) Full text (in our servers)
  20. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  21. Azizi F, Khoshniat M, Bahrainian M, Hedayati M. Thyroid function and intellectual development of infants nursed by mothers taking methimazole. J Clin Endocrinol Metab. 2000Abstract Full text (link to original source) Full text (in our servers)
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  23. Momotani N, Yamashita R, Makino F, Noh JY, Ishikawa N, Ito K. Thyroid function in wholly breast-feeding infants whose mothers take high doses of propylthiouracil. Clin Endocrinol (Oxf). 2000Abstract
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