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An antineoplastic alkylating agent indicated in the treatment of chronic lymphocytic leukemia, indolent non-Hodgkin’s lymphomas and multiple myeloma.
Intravenous administration on days 1 and 2 every 3 to 4 weeks, 3 to 6 cycles.
Since the date of last update we have not found published data on its excretion in breastmilk.
Its high percentage of protein binding and short half-life (AEMPS 2018, Lundbeck 2017, Darwish 2015, Dubbelman 2013, Preiss 1985) make it unlikely it will transfer into breastmilk in significant quantities.
Its practically zero oral bioavailability (Preiss 1985) would make its transfer to infant plasma from ingested breast milk difficult, except in premature infants and the immediate neonatal period when there may be greater intestinal permeability.
It is known from pharmacokinetics that after 3 elimination half-lives (T½) 87.5% of the drug is eliminated from the body; after 4 T½ it is 94%, after 5 T½ 96.9%, after 6 T½ 98.4% and after 7 T½ 99%. From 7 T½ the plasma concentrations of the drug in the body are negligible. In general, a period of five half-lives can be considered a safe waiting period before resuming breastfeeding (Anderson 2016).
When it is possible to do so, detections in milk of each patient to determine the total elimination of the drug would be the best indicator for resuming breastfeeding between two cycles of chemotherapy.
Expert authors recommend waiting 24 hours (12 T½ of the parent compound and 8 T½ of the metabolite M3) after the last dose before restarting breastfeeding. Meanwhile, express and discard breastmilk regularly (Briggs 2015).
Given the strong evidence that exists on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother that wishes to continue with breastfeeding (Koren 2013).