Last update Nov. 25, 2024

Dactinomycin; Actinomycin D

Incompatible

Very unsafe. Contraindicated. Use of an alternative or cessation of breastfeeding. Read the Commentary.

Dactinomycin is a highly toxic actinomycin antibiotic with antineoplastic and immunosuppressive properties. It is used in the treatment of Wilms' tumor, gestational trophoblastic tumors, sarcomas such as rhabdomyosarcoma and Ewing's sarcoma and other cancers. It frequently causes potentially serious adverse effects: anemia, pancytopenia, neuropathy, sepsis, liver toxicity, diarrhea... (Recordati 2018). Daily intravenous administration for 5 days.

At the date of the last update we found no published data on its excretion in breast milk.

Its high molecular weight would hinder its excretion in breast milk, but its low binding to plasma proteins could facilitate it.

Its low oral bioavailability makes it difficult for it to pass from ingested breast milk into infant plasma, except in premature infants and the immediate neonatal period when intestinal permeability may be higher.

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 it is 99%. From 7 T½ the plasma 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 breastfeeding again.(Anderson 2016).

Taking the longest T½ published as a reference (36 hours), these 5 T½ would correspond to 8 days. Meanwhile, breast milk must be expressed and discarded regularly. This does not allow breastfeeding during treatment.


See below the information of this related product:

  • Maternal Cancer; Maternal Neoplasia (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)

Alternatives

We do not have alternatives for Dactinomycin; Actinomycin D.

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

Dactinomycin; Actinomycin D in other languages or writings:

Groups

Dactinomycin; Actinomycin D belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Dactinomycin; Actinomycin D in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. Baja - Low %
Molecular weight 1255 daltons
Protein Binding 5 %
pKa 10.52 -
36 hours

References

  1. Recordati. Dactinomycin. Drug Summary. 2018 Full text (in our servers)
  2. Anderson PO. Cancer Chemotherapy. Breastfeed Med. 2016 May;11:164-5. Abstract Full text (link to original source) Full text (in our servers)
  3. 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 Abstract Full text (link to original source) Full text (in our servers)

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