Lepirudin
2006
Abstract
Lepirudin is no longer marketed in the United States. Limited information indicates that lepirudin in doses up to 100 mg daily produce very low levels in milk. Because of its large molecular weight, it would not be expected to be absorbed from breastmilk by the infant. Lepirudin would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.[1] The excretion of darbepoetin alfa in breastmilk or its effects on breastfed infants have not been studied. However, erythropoietin is a normal component of human milk and darbepoetin is immunologically and biologically indistinguishable from native erythropoietin. Intravenous darbepoetin has been given safely to newborn infants in doses much larger than those expected to appear in breastmilk. No special precautions are required during breastfeeding. There are no data on the use of interferon alfacon-1 during breastfeeding. However, the amounts of the similar drugs, interferon alfa and interferon beta-1a, excreted into milk are very low. Any interferon in breastmilk is probably destroyed in the infant’s gastrointestinal tract and not absorbed, except perhaps in neonates. Hepatitis C is not transmitted through breastmilk and breastmilk has been shown to inactivate hepatitis C virus (HCV).[1–4] However, the Centers for Disease Control recommends that mothers with HCV infection should consider abstaining from breastfeeding if their nipples are cracked or bleeding. It is not clear if this warning would apply to mothers who are being treated for hepatitis C. Infants born to mothers with HCV infection should be tested for HCV infection; because maternal antibody is present for the first 18 months of life and before the infant mounts an immunologic response, nucleic acid testing is recommended.[1,4]
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