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Retinoic acid form of vitamin A, with cytostatic effects. Indicated, together with arsenic trioxide, in the treatment of acute promyelocytic leukemia. Oral administration in two daily doses until complete remission or a maximum of 3 months.
At the date of the last update, there was no available published data on its excretion in breast milk.
Its pharmacokinetic data (very high percentage of protein binding, wide volume of distribution, low pKa and short half-life) make it unlikely that it will pass into breast milk in a clinically significant quantity.
It is known from Pharmacokinetics that after 3 elimination half-lives (T½), 87.5% of the drug is eliminated from the body; after 4 T½ 94%, after 5 T½ 96.9%, after 6 T½ 98.4% and after 7 T½ 99%. Above 7 T½, plasma drug concentrations in the body are negligible. In general, a period of five half-lives can be considered a safe waiting period to return to breastfeeding. (Anderson 2016)
Taking as reference the longest published T½ of all active metabolites (2 hours), these 5 T½ would correspond to 10 hours. Due to the significant adverse effects, it may be advisable to wait 7 T½, which would correspond to 14 hours. Meanwhile, express and discard breast milk regularly.
Breastfeeding must be discontinued during cancer treatment due to potentially serious side effects for the infant. Chemotherapy does not affect milk production during or after treatment. Abrupt weaning can be psychologically traumatic for both mother and infant (Pistilli 2013). If the mother wishes, milk production can be maintained by regular expression of the breast, and lactation can be restored in periods when no significant traces of the drug remain in the milk (Anderson 2016) or at the end of treatment (Pistilli 2013). Dosing every 12 hours and simultaneous treatment with other chemotherapeutic drugs make it very difficult to continue breastfeeding.
Given the strong evidence that exists on the benefits of breastfeeding for the development of babies and the health of mothers, it is convenient to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding. (Koren 2013)
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