Last update: March 30, 2021

Heparin

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

It is indicated for prophylaxis and treatment of venous or arterial thrombosis, pulmonary embolism and acute coronary syndrome.
Authorized use in neonates and infants.
Intravenous or subcutaneous use.

We did not find published data regarding the excretion of this substance through breast milk at the time this last update was completed.

The high molecular weight of both standard or non-fractionated Heparin and low molecular weight heparins makes it very unlikely to pass into breast milk in a significant quantity (Pfizer2016); manufacturers claim that it is not excreted in breast milk (AEMPS 2017, Hospira 2014).

In addition, heparins are inactivated in the gastrointestinal tract, not being absorbed (practically nil oral bioavailability), which prevents the passage into plasma of the infant from ingested breast milk (Pfizer2016).

There is virtually no excretion in human milk of other low molecular weight heparins such as dalteparin (Richter 2001) and there is an absence of anticoagulant activity in plasma of infants breastfed by mothers treated with enoxaparin (Guillonneau 1996).

Risk of Heparin-induced Thrombocytopenia and Osteoporosis in the mother is lower with low molecular weight heparins (Fuller 2013, Middeldorp 2011, Rath 2010).

Several medical societies, experts authors and expert consensus, consider the use of this medication to be safe or very probably safe during breastfeeding (Hale, Lactmed, Bates 2018 y 1997, Briggs 2015, Schaefer 2015, Rowe 2013, Fuller 2013, Yurdakök 2012, Rath 2010).

Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding (WHO 2000).

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

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

Heparin is also known as


Heparin in other languages or writings:

Group

Heparin belongs to this group or family:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 0 %
Molecular weight 15.000 (3.000 - 30.000) daltons
Protein Binding 95 %
VD 0,07 l/Kg
Tmax 0,3 hours
T1/2 1,5 (1 - 6) hours
M/P ratio 0 -

References

  1. Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. Abstract Full text (link to original source)
  2. AEMPS. Heparina. Ficha técnica. 2017 Full text (in our servers)
  3. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  4. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  5. Hospira NZ Limited. Heparin. Data Sheet. 2014 Full text (in our servers)
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  7. Fuller KP, Turner G, Polavarapu S, Prabulos AM. Guidelines for use of anticoagulation in pregnancy. Clin Lab Med. 2013 Abstract
  8. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012 Abstract
  9. Middeldorp S. How I treat pregnancy-related venous thromboembolism. Blood. 2011 Abstract Full text (link to original source) Full text (in our servers)
  10. Rath W. [Thromboprophylaxis during pregnancy and the puerperium: highlights from current guidelines]. Z Geburtshilfe Neonatol. 2010 Abstract
  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. Richter C, Sitzmann J, Lang P, Weitzel H, Huch A, Huch R. Excretion of low molecular weight heparin in human milk. Br J Clin Pharmacol. 2001 Abstract Full text (link to original source) Full text (in our servers)
  13. Bates SM, Ginsberg JS. Anticoagulants in pregnancy: fetal effects. Baillieres Clin Obstet Gynaecol. 1997 Abstract
  14. Guillonneau M, de Crepy A, Aufrant C, Hurtaud-Roux MF, Jacqz-Aigrain E. [Breast-feeding is possible in case of maternal treatment with enoxaparin]. Arch Pediatr. 1996 Abstract
  15. Kandrotas RJ. Heparin pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 1992 Abstract
  16. Estes JW. Clinical pharmacokinetics of heparin. Clin Pharmacokinet. 1980 Abstract
  17. Hale TW. Hale's Medications & Mothers' Milk. [Internet]. Springer Publishing Company; 1991-. Available from: https://www.halesmeds.com None
  18. Lactmed. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ None Full text (link to original source)

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