Last update: Aug. 30, 2021

Heparin

Very Low Risk for breastfeeding


Safe. Compatible.
Minimal risk for breastfeeding and infant.

Indicated in the treatment and prevention of arterial, venous or pulmonary thromboembolism and in acute coronary syndrome.
Authorized use in neonates and infants.
Intravenous, intraarterial or subcutaneous administration.

At the date of the last update, there was no available published data on its excretion in breast milk.

The high molecular weight of standard or unfractionated heparin and also of low molecular weight heparins makes their passage into breast milk in clinically significant amounts highly unlikely (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 zero oral bioavailability), which prevents the passage into plasma of the infant from ingested breast milk (Pfizer2016).

There has been virtually no excretion in breast milk of other lower molecular weight heparins such as dalteparin (Richter 2001). There is absence of anticoagulant activity in plasma of infants breastfed by mothers treated with enoxaparin (Guillonneau 1996).

The risk of heparin-induced thrombocytopenia and osteoporosis is lower with low molecular weight heparins (Fuller 2013, Middeldorp 2011, Rath 2010).

Various medical societies, experts, and expert consensus consider the use of this medication safe during breastfeeding (Hale, Lactmed, Bates 2018 and 1997, Briggs 2015, Schaefer 2015, Rowe 2013, Fuller 2013, Yurdakök 2012, Rath 2010).

WHO 2002 Essential Medicines List: compatible with breastfeeding (WHO 2002).

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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