Last update Feb. 16, 2021
Very Low Risk
It is a recombinant humanised monoclonal antibody (IgG1 immunoglobulin) produced by recombinant DNA technology.
It works by blocking the vascular endothelial growth factor.
Intravitreal administration is used in macular degeneration due to choroidal neovascularization.
It is excreted in breastmilk in clinically insignificant amounts, with undetectable levels (McFarland 2015, Ehlken 2012) and no problems have been observed in infants whose mothers had been given it (Mc Farland 2015, Tarantola 2010).
Intravitreal administration: the small dose and the minimal transfer to blood from the vitreous humor as well as there being no detected levels in breastmilk or side effects in infants make this type of administration safe during breastfeeding.
A study has recorded a 35% decrease in the concentration of vascular endothelial growth factor (VEGF) in breastmilk, without specifying problems in the infant, for this reason some authors recommend the use of ranibizumab which does not seem to decrease the concentration of VEGF (Ehlken 2012).
Null or negligible passage into breast milk of similar monoclonal antibodies, such as adalimumab, belimumab, certolizumab, golimumab, infliximab, ipilimumab, natalizumab, rituximab, tocilizumab and ustekinumab has been confirmed (Bar-Gil 2021, LaHue 2020, Saito 2020, 2019 and 2018, Krysko 2019, Whittam 2019, Klenske 2019, Matro 2018, Anderson 2018, Bragnes 2017, Witzel 2014, Ross 2014, Fritzsche 2012).
Due to its protein nature, it is inactivated in the gastrointestinal tract without being absorbed (practically nil oral bioavailability) and this hinders or prevents its passage into the infant´s plasma from ingested breast milk (Lactmed, Rademaker 2018, Bragnes 2017, Götestam 2016 , Witzel 2014, Butler 2014, Mervic 2014) except for premature infants and during the immediate neonatal period when there might be a greater intestinal permeability (Sammaritano 2020).
No problems have been detected in infants whose mothers received other similar monoclonal antibodies such as belimumab, bevacizumab, infliximab, rituximab, tocilizumab, or ustekinumab (Bar-Gil 2021, LaHue 2020, Saito 2020, 2019 and 2018, Klenske 2019, Mugheddu 2019, Krysko 2019, Matro 2018, Bragnes 2017, Hyrich 2014, Danve 2014).
Expert authors consider that the use of monoclonal antibodies during breastfeeding is safe or very likely to be safe (Whittam 2019, Matro 2018, Anderson 2018 and 2016, Witzel 2014, Pistilli 2013).
Given the strong evidence that exists on the benefits of breastfeeding and the development of babies and the health of their mothers, it might be appropriate to evaluate the risk-benefit of any maternal treatment, including chemotherapy, and counsel individually each mother who wishes to continue breastfeeding (Koren 2013).
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.
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