Ciclosporin

Immunosuppressant which is an inhibitor of calcineurin and used in the prevention of transplanted organ rejection (kidney, liver, heart ...) and in the treatment of severe forms of autoimmune diseases: Atopic Eczema, Psoriasis, Rheumatoid Arthritis, Ulcerative Colitis, Aplastic Anemia, Asthma, Behçet's Syndrome, Chronic Active Hepatitis, Multiple Sclerosis, Myasthenia Gravis, Sarcoidosis, Scleritis or Uveitis and Scleroderma, among others. Orally administrated for systemic use in one or two daily doses, parenteral injection, eye drops and inhalation.

Its high molecular weight and high protein-binding capacity explain the low excretion (<0.36 mg / L) obtained in colostrum and mature breastmilk. ^{(Kociszewska 2020, ​​​​​​​Mazzuoccolo 2014, Osadchy 2011, Moretti 2003, Munoz-Flores 2001, Nyberg 1998, Thiru 1997, Behrens 1989, Ziegenhagen 1988, Flechner 1985, Lewis 1983)}

No short or long term issues on developmental or immunological response have been observed in infants whose mothers were taking this drug. ^{(Lahiff 2011, Morton2011, Moretti 2003, Munoz-Flores 2001, Nyberg 1998)} 

Plasma levels in most of these infants were undetectable or very low ^{(Osadchy 2011, Lahiff 2011, Morton2011, Moretti 2003, Munoz-Flores 2001, Nyberg 1998, Ziegenhagen 1988)}. Only one exception has been reported who presented therapeutic levels. ^{(Moretti 2003)}

Its low oral bioavailability, even lower when taken along with food, mostly fatty food, would decrease the passage to infant's plasma from the ingested breastmilk.

Although thought to be high, the total amount of alcohol contained in each dose of drug is considered not enough to contraindicate this medication during breastfeeding.

There are isolated reports which indicate that cyclosporine may decrease prolactin levels. ^{(Nagar 1992, Ramirez 1991)}

Infants who have been exposed to calcineurin inhibitors during pregnancy may have immunized deficiency in the first year of life ^{(Grimer 2007)}, hence the importance of not being deprived of breastfeeding for no proven reason.

Several medical societies and experts agree that the use of this medication during breastfeeding is safe. ^{(Sammaritano 2020, Götestam-Skorpen 2016, Flint 2016, Constantinescu 2014, Thiagarajan 2013, van der Houde 2010)}