Last update March 24, 2019
Capecitabine is a prodrug which is converted into fluorouracil and other active metabolites in body tissues (EMA 2018, Derissen 2016, Calzas 2003). It is used as a treatment for colon, colorectal, breast and gastric cancers.
It is administered orally twice a day in 14-day cycles followed by a 7-day rest for 6 months (EMA 2018).
Since the last update we have not found published data on the excretion of capecitabine in breastmilk, but its active metabolite, fluorouracil, is excreted in breastmilk in undetectable, clinically insignificant amounts (Peccatori 2012) which can be explained by its pharmacokinetics: fast degradation to non-active metabolites and very low liposolubility (Pistilli 2013).
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 at least five half-lives can be considered a safe waiting period before breastfeeding again (Anderson 2016).
Taking as reference the longest published T½ of all the active metabolites (EMA 2018), these 5 T½ would correspond to 5.5 hours. Due to major side effects, it would be advisable to wait 7 T½, which would correspond to 8 hours. Meanwhile, express and discard milk from the breast regularly.
Some authors recommend waiting 24 hours (21 T½) after the last dose to resume breastfeeding. (Hale 2017 p.148).
During breast cancer treatment, breastfeeding must be interrupted due to potentially serious side effects for the infant. Chemotherapy does not affect milk production during or after treatment. Abrupt weaning can be psychologically traumatic for both the mother and the infant (Pistilli 2013). If the mother wishes, production of milk can be maintained by regular expressing of the breast, resumption of breastfeeding being possible in the periods in which no significant traces of the drug remain in the milk (Anderson 2016) or at the end of the treatment (Pistilli 2013).
Some chemotherapeutic agents with an antibiotic effect can alter the composition of the microbiota (bacterial set or bacterial flora) of breastmilk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, although no harmful effects are assumed or have been reported in breastfed infants.
Women undergoing chemotherapy during pregnancy have lower rates of breastfeeding due to difficulties in breastfeeding (Stopenski 2017), needing more support to achieve it.
Given the strength of the existing evidence on the benefits of breastfeeding for the development of babies and the health of mothers, the risk-benefit of any maternal treatment should be evaluated, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding (Koren 2013).
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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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