Last update July 16, 2022
Very Low Risk
Monoclonal antibody, immunoglobulin G anti CD20 composed of 664 amino acids. Indicated in the treatment of rheumatoid arthritis, non-Hodgkin's lymphoma, chronic lymphocytic leukemia, granulomatosis with polyangiitis (Wegener) and associated with methotrexate in severe active rheumatoid arthritis. Intravenous administration every week, two weeks or two months depending on the disease being treated.
It is excreted in breast milk in very small amounts (Bosshard 2021, Krysko 2019, Bragnes 2017) in line with its very high molecular weight, as is the case with other IgG1 monoclonal antibodies such as infliximab and adalimumab. (Bragnes 2017, Fritzsche 2012)
The plasma levels of infants whose mothers take them are no detectable. (Bosshard 2021)
An infant whose mother received a dose of 1 g of Rituximab at 3 months had no side effects at 1.5 years of follow-up (Bragnes 2017). Five other infants had no problems after 8 to 12 months of follow-up (Hersey 2020, Krysko 2019). The blood counts and immunoglobulins of 6 other infants were normal. (Rød 2022)
Due to its protein nature it is inactivated in the gastrointestinal tract, not being absorbed, (oral bioavailability practically null), which hinders or prevents the passage to infant plasma from the ingested breast milk (Bragnes 2017, Götestam 2016, Butler 2014, Pistilli 2013), except in premature babies and the immediate neonatal period, when there may be greater intestinal permeability.
Based on its pharmacological properties, breastfeeding should not be discouraged when using rituximab if no other options are available (Bosshard 2021, Krysko 2019, Whittam 2019, Götestam-EULAR 2016). Although previously not recommended during lactation (Makol 2011), especially during the neonatal period and in case of prematurity (Almas 2016, Ostensen 2009), more recently, various experts (Bosshard 2021, Sammaritano 2020, Ciplea 2020, Krysko 2019, Bragnes 2017, Noviani 2016, Pistilli 2013) consider safe or probably safe the use of this medication during lactation.
Given the strong evidence that exists on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother that wishes to continue with breastfeeding. (Koren 2013)
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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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2015 of United States of America
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM