Last update Aug. 1, 2018

Cisplatin

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

An alkylating agent composed of a heavy metal derived from platinum, with antineoplastic properties due to inhibiting DNA synthesis.
Used intravenously in the treatment of advanced or metastatic cancers (ovarian, testicular, lung).

There is confusion with the elimination half-life of cisplatin. The plasma half-life of cisplatin is 20 to 30 minutes (AEMPS 2013, Bristol 2010). The compounds bound to albumin, with a high percentage of binding (> 90%), are slowly eliminated with a half-life of 4-5 days (Drugbank.com, AEMPS 2013, Bristol 2010), but these compounds do not have antineoplastic activity (AEMPS 2013) nor have they been measured in milk.

It is known from Pharmacokinetics that after 3 elimination half-lives (T½), 87.5% of the drug is eliminated from the body; 94% after 4 T½, 96.9% after 5 T½, 98.4% after 6 T½ and 99% after 7 T½. From 7 T½ the plasmatic concentrations of the drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before resuming breastfeeding (Anderson 2016).

If the half-life of the antineoplastic product is considered, it would only take 3 to 4 hours (7 half-lives) to wait before resuming breastfeeding, expressing and discarding breastmilk in the meantime.

Six different studies have analyzed the excretion of cisplatin in breastmilk (Hays 2013, Tesfaye 2013, Lanowska 2011, Ben-Baruch 1992, de Vries 1989 and Egan 1985), each with one case, except Lanowska who describes 3 cases and Tesfaye 2 cases. Cisplatin concentrations found in milk in the first 24-48 hours after administration were: 0.9 mg/L (de Vries 1989), 0.15 mg/L (Ben-Baruch 1992) and 0.2, 1,4 and 5.5 mg/L (Lanowska 2011).

The other three authors (Hays 2013, Tesfaye 2013 and Egan 1985) found concentrations in milk below the limit of detection:
- After a first administration of 70 mg of cisplatin there was a milk concentration of 0.016 mg/L at 5 hours, falling below the limit of detection after 17 hours and being totally undetectable at 66 hours, so the author (Hays 2013) believes that you can breastfeed again after waiting 3 days, having expressed and discarded breastmilk during those 72 hours.
- In two women, no detectable levels of platinum were found in the milk of either of the two (Tesfaye 2013).
- In another study (Egan 1985), after the infusion of 130 mg of cisplatin, plasma levels of the mother were rising but no detectable levels of cisplatin were found in milk in any of the multiple measurements made in the first 71 hours after infusion.

It must also be considered that its low oral bioavailability prevents its transfer to infant plasma from ingested breast milk, except in premature infants and the immediate neonatal period in which there may be increased intestinal permeability.

Due to all these findings, opinions among authors and associations are divided: those who consider that it is not prudent to breastfeed if milk levels can not be measured or until 20 days have passed after administration (Hale 2017, p.204), those who consider it better to stop breastfeeding (Pistilli 2013, WHO 2002), those who think that we must carefully weigh benefits and risks (Koren 2013), those who do not give an opinion (Moretti 2000) and those who believe that it is compatible with breastfeeding, Hays in 2013 and the American Academy of Pediatrics (AAP 2001) based on the 1985 Egas study.

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).

Alternatives

We do not have alternatives for Cisplatin.

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

Cisplatin is also known as


Cisplatin in other languages or writings:

Group

Cisplatin belongs to this group or family:

Tradenames

Main tradenames from several countries containing Cisplatin in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. Baja - Low %
Molecular weight 300 daltons
Protein Binding > 90 %
VD 0.3 - 1 l/Kg
pKa 6. 56 -
Tmax 1 hours
0.3 - 0.8 hours
M/P ratio 0.1 - 1.1 -
Theoretical Dose 0.02 - 0.83 mg/Kg/d
Relative Dose 0.3 - 0.4 %

References

  1. DRUGBANK ONLINE. DrugBank.com 2006 - Consulted on April 18, 2022 Full text (link to original source)
  2. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  3. Anderson PO. Cancer Chemotherapy. Breastfeed Med. 2016 May;11:164-5. Abstract Full text (link to original source) Full text (in our servers)
  4. AEMPS. Cisplatino. Ficha técnica. 2013 Full text (in our servers)
  5. Hays KE, Ryu RJ, Swisher EM, Reed E, McManus T, Rybeck B, Petros WP, Hebert MF. Duration of cisplatin excretion in breast milk. J Hum Lact. 2013 Abstract Full text (link to original source) Full text (in our servers)
  6. Tesfaye H, Halaska MJ, Branova P et al. Breast-fed infants whose mothers were on platinum based chemotherapy: Cases with promising outcomes. Poster at 13th International Congress of Therapeutic Drug Monitoring & Clinical Toxicology. Ther Drug Monit. 2013;35:693. 2013
  7. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013 May;39(3):207-11. Abstract
  8. Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V; Society of Obstetricians and Gynaecologists of Canada. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013 Mar;35(3):263-278. Abstract Full text (link to original source) Full text (in our servers)
  9. Lanowska M, Köhler C, Oppelt P, Schmittel A, Gottschalk E, Hasenbein K, Schneider A, Marnitz S. Addressing concerns about cisplatin application during pregnancy. J Perinat Med. 2011 Abstract
  10. Bristol-Myers Squibb. Cisplatin. Drug Summary. 2010 Full text (in our servers)
  11. 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)
  12. 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)
  13. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  14. Ben-Baruch G, Menczer J, Goshen R, Kaufman B, Gorodetsky R. Cisplatin excretion in human milk. J Natl Cancer Inst. 1992 Abstract
  15. de Vries EG, van der Zee AG, Uges DR, Sleijfer DT. Excretion of platinum into breast milk. Lancet. 1989 Abstract
  16. Egan PC, Costanza ME, Dodion P, Egorin MJ, Bachur NR. Doxorubicin and cisplatin excretion into human milk. Cancer Treat Rep. 1985 Abstract

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