Last update: May 1, 2016

Warfarin

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

Coumarin-type anticoagulant drug for the treatment and prophylaxis of thromboembolic disorders.

Warfarin is not detected in breast milk. Not problems have been observed in infants whose mothers were treated. Plasma levels of warfarin in such infants were undetectable.

Even in cases of accidental maternal overdosing, infants did not show any clinical problem and/or coagulation tests were not altered.

American Academy of Pediatrics states that it is a medication usually compatible with breastfeeding.
WHO List of Essential Medicines 2002: compatible with breastfeeding.

Alternatives

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

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Warfarin in other languages or writings:

Group

Warfarin belongs to this group or family:

Tradenames

Main tradenames from several countries containing Warfarin in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 308 daltons
Protein Binding 99 %
VD 0,14 l/Kg
Tmax 1 - 9 hours
T1/2 31 - 48 hours
M/P ratio 0,2 -
Theoretical Dose <0,0001 mg/Kg/d
Relative Dose 0,01 %
Ped.Relat.Dose 0,003 %

References

  1. Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. Abstract Full text (link to original source)
  2. Noviani M, Wasserman S, Clowse ME. Breastfeeding in mothers with systemic lupus erythematosus. Lupus. 2016 Aug;25(9):973-9. Abstract
  3. Marshall AL. Diagnosis, treatment, and prevention of venous thromboembolism in pregnancy. Postgrad Med. 2014 Abstract
  4. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  5. Fuller KP, Turner G, Polavarapu S, Prabulos AM. Guidelines for use of anticoagulation in pregnancy. Clin Lab Med. 2013 Abstract
  6. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012 Abstract
  7. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; American College of Chest Physicians. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-e736S. Abstract Full text (link to original source) Full text (in our servers)
  8. Middeldorp S. How I treat pregnancy-related venous thromboembolism. Blood. 2011 Abstract Full text (link to original source) Full text (in our servers)
  9. Schindler D, Graham TP. Warfarin Overdose in a Breast-feeding Woman. West J Emerg Med. 2011 Abstract
  10. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  11. Dresang LT, Fontaine P, Leeman L, King VJ. Venous thromboembolism during pregnancy. Am Fam Physician. 2008 Abstract
  12. 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)
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  14. Clark SL, Porter TF, West FG. Coumarin derivatives and breast-feeding. Obstet Gynecol. 2000 Abstract
  15. Greer IA. The special case of venous thromboembolism in pregnancy. Haemostasis. 1998 Abstract
  16. Bates SM, Ginsberg JS. Anticoagulants in pregnancy: fetal effects. Baillieres Clin Obstet Gynaecol. 1997 Abstract
  17. Leys D, Lamy C, Lucas C, Hénon H, Pruvo JP, Codaccioni X, Mas JL. Arterial ischemic strokes associated with pregnancy and puerperium. Acta Neurol Belg. 1997 Abstract
  18. Letsky EA. Peripartum prophylaxis of thrombo-embolism. Baillieres Clin Obstet Gynaecol. 1997 Abstract
  19. Hirsh J. Optimal intensity and monitoring warfarin. Am J Cardiol. 1995 Abstract
  20. Olthof E, de Vries TW. [Breast feeding and oral anticoagulants]. Tijdschr Kindergeneeskd. 1993 Abstract
  21. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9. Abstract
  22. Toll LL. Anticoagulant use during breastfeeding. J Hum Lact. 1991 Abstract
  23. Ginsberg JS, Hirsh J. Optimum use of anticoagulants in pregnancy. Drugs. 1988 Abstract
  24. McKenna R, Cole ER, Vasan U. Is warfarin sodium contraindicated in the lactating mother? J Pediatr. 1983 Abstract
  25. Dardick KR. Warfarin during lactation. Conn Med. 1980 Abstract
  26. Orme ML, Serlin MJ, Breckenridge A. Thromboembolism in pregnancy. Br Med J. 1979 Abstract
  27. Orme ML, Lewis PJ, de Swiet M, Serlin MJ, Sibeon R, Baty JD, Breckenridge AM. May mothers given warfarin breast-feed their infants? Br Med J. 1977 Abstract
  28. De Swiet M, Lewis PJ. Excretion of anticoagulants in human milk. N Engl J Med. 1977 Abstract

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