Last update Aug. 3, 2022

Anakinra

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

It is a recombinant form of human interleukin-1 receptor antagonist (IL-1Ra) used, alone or associated with methotrexate, in the treatment of rheumatoid arthritis, neonatal-onset multisystem inflammatory disease and deficiency of interleukin-1 receptor antagonist. Subcutaneous administration once daily.

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

Being a polypeptide of 153 amino acids with a large molecular weight, it is very unlikely to pass into breast milk.

Its low oral bioavailability makes it difficult for it to pass to the infant’s plasma via ingested breast milk as, due to its protein nature, it degrades in the gastrointestinal tract and is not absorbed.

No problems have been observed in infants of mothers treated with anakinra. (Duman 2019, Smith 2018, Youngstein 2017, Chang 2014, Berger 2009)

Expert authors consider the use of this medication compatible with breastfeeding if no other options are available. (Hale, LactMed, Sammaritano 2020, Götestam 2016, Briggs 2015, Grunewald 2015, Witzel 2014)

Alternatives

  • Adalimumab (Safe substance and/or breastfeeding is the best option.)
  • Certolizumab (Safe substance and/or breastfeeding is the best option.)
  • Etanercept (Safe substance and/or breastfeeding is the best option.)
  • Infliximab (Safe substance and/or breastfeeding is the best option.)
  • Tocilizumab (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

Anakinra in other languages or writings:

Group

Anakinra belongs to this group or family:

Tradenames

Main tradenames from several countries containing Anakinra in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 0 %
Molecular weight 17.258 daltons
VD 0.26 l/Kg
Tmax 3 - 7 hours
4 - 6 hours

References

  1. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on April 16, 2024 Full text (link to original source)
  2. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  3. Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, Marder W, Guyatt G, Branch DW, Buyon J, Christopher-Stine L, Crow-Hercher R, Cush J, Druzin M, Kavanaugh A, Laskin CA, Plante L, Salmon J, Simard J, Somers EC, Steen V, Tedeschi SK, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Apr;72(4):529-556. Abstract Full text (link to original source)
  4. Duman NC, Goren MZ, Karaalp A. Anakinra use during pregnancy and lactation: A case report. Reprod Toxicol 2019;88:139-40. Abstract #20.
  5. Smith CJF, Chambers CD. Five successful pregnancies with antenatal anakinra exposure. Rheumatology (Oxford). 2018 Jul 1;57(7):1271-1275. Abstract Full text (link to original source)
  6. Youngstein T, Hoffmann P, Gül A, Lane T, Williams R, Rowczenio DM, Ozdogan H, Ugurlu S, Ryan J, Harty L, Riminton S, Headley AP, Roesler J, Blank N, Kuemmerle-Deschner JB, Simon A, Woolf AS, Hawkins PN, Lachmann HJ. International multi-centre study of pregnancy outcomes with interleukin-1 inhibitors. Rheumatology (Oxford). 2017 Dec 1;56(12):2102-2108. Abstract Full text (link to original source)
  7. 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. 2016 May;75(5):795-810. Abstract Full text (link to original source) Full text (in our servers)
  8. Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation. J Dtsch Dermatol Ges. 2015 Abstract Full text (link to original source) Full text (in our servers)
  9. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  10. Chang Z, Spong CY, Jesus AA, Davis MA, Plass N, Stone DL, Chapelle D, Hoffmann P, Kastner DL, Barron K, Goldbach-Mansky RT, Stratton P. Anakinra use during pregnancy in patients with cryopyrin-associated periodic syndromes (CAPS). Arthritis Rheumatol. 2014 Nov;66(11):3227-32. Abstract Full text (link to original source)
  11. Witzel SJ. Lactation and the use of biologic immunosuppressive medications. Breastfeed Med. 2014 Dec;9(10):543-6. Abstract Full text (link to original source) Full text (in our servers)
  12. Berger CT, Recher M, Steiner U, Hauser TM. A patient's wish: anakinra in pregnancy. Ann Rheum Dis. 2009 Abstract
  13. EMEA Anakinra Ficha técnica 2007 Full text (in our servers)
  14. EMEA Anakinra Data Sheet 2007 Full text (in our servers)
  15. Buescher ES, Hair PS. Human milk anti-inflammatory component contents during acute mastitis. Cell Immunol. 2001 Abstract
  16. Buescher ES, Malinowska I. Soluble receptors and cytokine antagonists in human milk. Pediatr Res. 1996 Abstract

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