Last update Oct. 11, 2017

l-Glutamic acid polymer with l-alanine, l-lysine and l-tyrosine, acetate

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

A synthetic polypeptide of 4 amino acids (l-alanine, l-glutamic, l-lysine and l-tyrosine), similar to myelin which is indicated in recurrences of multiple sclerosis (Ziemssen 2001).

Its high molecular weight makes it unlikely it will be excreted in breast milk and due to its protein nature it would be destroyed in the stomach of the infant, not absorbed, so its oral bioavailability is practically zero, except in premature babies and in the immediate neonatal period, where there may be greater intestinal permeability (2016 Almas, Cree 2013).

No problems have been observed in breastfeeding infants for periods ranging from 1 to 12 months whose mothers were taking glatiramer (Fragoso 2014, Hellwig 2012 and 2011, Fragoso 2010).

Glatiramer injected subcutaneously is hydrolyzed locally in amino acids and short peptides, so there are no appreciable levels of glatiramer in plasma. Severe side effects are unusual.

For some authors (Fragoso 2014) glatiramer would be the best multiple sclerosis disease-modifying drug to take during breastfeeding. One in 10 neurologists prescribe it during breastfeeding (Coyle 2004).

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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Other names

l-Glutamic acid polymer with l-alanine, l-lysine and l-tyrosine, acetate is Glatiramer Acetate in Chemical name.

Is written in other languages:

Group

l-Glutamic acid polymer with l-alanine, l-lysine and l-tyrosine, acetate belongs to this group or family:

Tradenames

Main tradenames from several countries containing l-Glutamic acid polymer with l-alanine, l-lysine and l-tyrosine, acetate in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. Baja - Poor %
Molecular weight 5.000 - 9.000 daltons

References

  1. Krysko KM, Dobson R, Alroughani R, Amato MP, Bove R, Ciplea AI, Fragoso Y, Houtchens M, Jokubaitis VG, Magyari M, Abdelnasser A, Padma V, Thiel S, Tintore M, Vukusic S, Hellwig K. Family planning considerations in people with multiple sclerosis. Lancet Neurol. 2023 Apr;22(4):350-366. Abstract
  2. Sánchez-Velasco S, Midaglia L, Vidal-Jordana A, Castillo F, Horno R, Carreras E, Serrano B, Bosch M, Agustí A, Montalban X, Tintoré M. Fármacos modificadores de la enfermedad en la esclerosis múltiple durante la lactancia: revisión de la evidencia actual. Rev Neurol. 2023 Jan 1;76(1):21-30. Abstract Full text (link to original source)
  3. Collorone S, Kodali S, Toosy AT. The protective role of breastfeeding in multiple sclerosis: Latest evidence and practical considerations. Front Neurol. 2023 Jan 24;13:1090133. Abstract Full text (link to original source)
  4. Langer-Gould AM. Pregnancy and Family Planning in Multiple Sclerosis. Continuum (Minneap Minn). 2019 Jun;25(3):773-792. Abstract
  5. Almas S, Vance J, Baker T, Hale T. Management of Multiple Sclerosis in the Breastfeeding Mother. Mult Scler Int. 2016;2016:6527458. Abstract Full text (link to original source) Full text (in our servers)
  6. Alroughani R, Altintas A, Al Jumah M, Sahraian M, Alsharoqi I, AlTahan A, Daif A, Dahdaleh M, Deleu D, Fernandez O, Grigoriadis N, Inshasi J, Karabudak R, Taha K, Totolyan N, Yamout BI, Zakaria M, Bohlega S. Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks. Mult Scler Int. 2016 Abstract Full text (link to original source) Full text (in our servers)
  7. Fragoso YD. Glatiramer acetate to treat multiple sclerosis during pregnancy and lactation: a safety evaluation. Expert Opin Drug Saf. 2014 Abstract
  8. Cree BA. Update on reproductive safety of current and emerging disease-modifying therapies for multiple sclerosis. Mult Scler. 2013 Jun;19(7):835-43. Abstract Full text (link to original source) Full text (in our servers)
  9. Fragoso YD, Boggild M, Macias-Islas MA, Carra A, Schaerer KD, Aguayo A, de Almeida SM, Alvarenga MP, Alvarenga RM, Alves-Leon SV, Arruda WO, Brooks JB, Comini-Frota ER, Ferreira ML, Finkelsztejn A, Finkelsztejn JM, de Freitas LD, Gallina AS, da Gama PD, Georgetto S, Giacomo MC, Gomes S, et al. The effects of long-term exposure to disease-modifying drugs during pregnancy in multiple sclerosis. Clin Neurol Neurosurg. 2013 Abstract
  10. Hellwig K, Haghikia A, Rockhoff M, Gold R. Multiple sclerosis and pregnancy: experience from a nationwide database in Germany. Ther Adv Neurol Disord. 2012 Sep;5(5):247-53. Abstract Full text (link to original source) Full text (in our servers)
  11. Hellwig K, Gold R. Glatiramer acetate and interferon-beta throughout gestation and postpartum in women with multiple sclerosis. J Neurol. 2011 Abstract
  12. Fragoso YD, Finkelsztejn A, Kaimen-Maciel DR, Grzesiuk AK, Gallina AS, Lopes J, Morales NM, Alves-Leon SV, de Almeida SM. Long-term use of glatiramer acetate by 11 pregnant women with multiple sclerosis: a retrospective, multicentre case series. CNS Drugs. 2010 Abstract
  13. Coyle PK, Christie S, Fodor P, Fuchs K, Giesser B, Gutierrez A, Lynn J, Weinstock-Guttman B, Pardo L; Women Neurologists MS Initiative. Multiple sclerosis gender issues: clinical practices of women neurologists. Mult Scler. 2004 Abstract
  14. Ziemssen T, Neuhaus O, Hohlfeld R. Risk-benefit assessment of glatiramer acetate in multiple sclerosis. Drug Saf. 2001 Abstract

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