Breast-feeding during maternal use of azathioprine

被引:74
作者
Moretti, Myla E.
Verjee, Zul
Ito, Shinya
Koren, Gideon
机构
[1] Hosp Sick Children, Motherisk Program, Div Clin Pharmacol & Toxicol, Toronto, ON M5G 1X8, Canada
[2] Hosp Sick Children, Dept Peadiat Lab Med, Div Clin Pharmacol & Toxicol, Toronto, ON M5G 1X8, Canada
[3] Univ Toronto, Dept Pediat, Toronto, ON, Canada
[4] Univ Western Ontario, Dept Med, Ivey Chair Mol Toxicol, London, ON, Canada
关键词
azathioprine; breast-feeding; lactation; 6-mercaptopurine;
D O I
10.1345/aph.1H152
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
OBJECTIVE: To report the clinical outcome of infants whose mothers were taking azathioprine while nursing and to quantify the transfer of 6-mercaptopurine (6-MP), its active metabolite, into breast milk. CASE SUMMARY: We report on a series of 4 patients treated with azathioprine while lactating. Breast milk samples were analyzed for 6-MP in 2 of the mothers. Several milk samples per patient were analyzed; levels of 6-MP were undetectable by high performance liquid chromatography (limit of detection 5 ng/mL). Therefore, the absolute relative infant dose would have been less than 0.09% of the maternal weight-adjusted dose. No adverse effects were encountered in any of the 4 infants. DISCUSSION: A large number of women of reproductive age are treated with azathioprine for a range of chronic conditions that require immunosuppression, such as systemic lupus erythematosus or solid organ transplants. Similar to other antimetabolites, the drug has generally been contraindicated for use during breast-feeding because of the theoretical concern for toxicity in the nursing infant. The available literature in this area is sparse and dated. The data presented here confirm published reports of minimal 6-MP excretion into milk, suggesting that significant systemic adverse effects in the infant are unlikely. CONCLUSIONS: Maternal azathioprine use during lactation does not appear to pose a significant immediate clinical risk to the suckling infant. Continued monitoring and long-term assessment of these infants are warranted.
引用
收藏
页码:2269 / 2272
页数:4
相关论文
共 15 条
[1]  
American Academy of Pediatrics Committee on Drugs, 2001, Pediatrics, V108, P776
[2]  
BAR OB, 2001, TRANSPLANTATION, V71, P1051, DOI DOI 10.1097/00007890-200104270-00006
[3]  
Bennett PN., 1996, DRUGS HUMAN LACTATIO
[4]   Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine [J].
Chan, TM ;
Tse, KC ;
Tang, CSO ;
Lai, K ;
Li, FK .
LUPUS, 2005, 14 (04) :265-272
[5]  
COULAM CB, 1982, TRANSPLANT P, V14, P605
[6]   Azathioprine, 6-Mercaptopurine in Inflammatory Bowel Disease: Pharmacology, Efficacy, and Safety [J].
Dubinsky, Marla C. .
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2004, 2 (09) :731-743
[7]   Pregnancy and autoimmune diseases [J].
Gordon, C .
BEST PRACTICE & RESEARCH IN CLINICAL RHEUMATOLOGY, 2004, 18 (03) :359-379
[8]  
GREKAS D, 1986, BIOL RES PREG PERIN, V7, P118
[9]   IMMUNOSUPPRESSIVE THERAPY AND BREAST-FEEDING AFTER RENAL-TRANSPLANTATION [J].
GREKAS, DM ;
VASILIOU, SS ;
LAZARIDES, AN .
NEPHRON, 1984, 37 (01) :68-68
[10]   The impact of thiopurine S-methyltransferase polymorphism on azathioprine-induced myelotoxicity in renal transplant recipients [J].
Kurzawski, M ;
Dziewanowski, K ;
Gawronska-Szklarz, B ;
Domanski, L ;
Drozdzik, M .
THERAPEUTIC DRUG MONITORING, 2005, 27 (04) :435-441