Safety in lactation: Drugs for chronic bowel disorders

Additional information relating to breastfeeding
To be used in conjunction with individual drug entries for specific information and guidance.

  • Aminosalicylates for chronic bowel disorders
    Mesalazine is the pharmacological basis for the four available aminosalicylates. A small number of poor, and largely anecdotal, cases of mesalazine-related diarrhoea have been reported. These drugs are not contraindicated but, if used, monitoring of the infant for diarrhoea is advised.
    Sulfasalazine carries an additional small risk over the other aminosalicylates.
    Mesalazine has more evidence and clinical experience than balsalazide and olsalazine.

 

  • Corticosteroids for chronic bowel disorders
    There is no direct evidence relating to the use of oral or rectal corticosteroids for chronic bowel disorders during breastfeeding.
    Avoid prolonged high dose therapy where possible since adrenal suppression and other adverse effects may theoretically occur in the infant. Where such use is unavoidable, monitor the infant’s adrenal function.
    Short-term use of high dose steroids are normally considered compatible with breastfeeding as the overall exposure will be low.

 

  • Immunoreactants and other drugs for chronic bowel disorders
    Drugs in this group, except teduglutide, affect the immune response to various chronic inflammatory and autoimmune diseases. The choice of drug will depend on a number of variables, including the indication, response to other drugs and the clinical condition of the patient.
    They may be used in combination with other immunomodulators. It is, therefore, difficult to suggest an alternative in most situations. The risk of additive adverse effects occurring in the breastfed infant must also be considered.
    A decision on whether to use immunoreactants in a breastfeeding mother, or whether to withhold breastfeeding, should be made after a careful assessment of the risk and benefits for each individual patient. Infants should be monitored for signs of infection and immunosuppression.
AdalimumabAzathioprineBalsalazideBeclometasoneBudesonideCiclosporinGastrointestinal disordersGolimumabHydrocortisoneInfliximabMercaptopurineMesalazineMethotrexateObstetrics and gynaecologyOlsalazinePaediatric and neonatal medicinePrednisoloneSafety in LactationSulfasalazineTeduglutideUstekinumabVedolizumab