Use with caution

Low dose aspirin (75mg to 150mg daily)  passes into breast milk in negligible amounts.  It can be used with caution during breastfeeding but monitoring is required..  Avoid if the infant has symptoms of a viral infection or fever.

Monitoring

As a precaution, monitor the infant for poor feeding, irritability or skin reactions, and for signs of bruising or bleeding, which may be prolonged.

Further information

Much of the evidence relates to higher analgesic or anti-inflammatory doses, and there is only very limited evidence relating to low dose aspirin as an antiplatelet agent during breastfeeding.

Its pharmacokinetics are likely to limit the amount excreted into breast milk.  Published data found negligible levels in milk after daily doses of 81mg.  Infants would have ingested approximately 0.4% of the weight-adjusted maternal dose.

It can be used therapeutically in full-term neonates from birth.

Aspirin has irreversible anti-platelet effects so any that is absorbed by the infant could have a prolonged effect

No side effects have been reported in infants after exposure to low doses of aspirin via breastmilk. Single case reports of metabolic acidosis, thrombocytopenia, petechiae, and anorexia in infants exposed to high or unknown doses of aspirin through breastmilk have been reported, although there are insufficient details to confirm a causal link.

See above for information about aspirin and Reye’s syndrome.

Use with caution

There is no information on the amount of clopidogrel which passes into breast milk although levels are likely to be low.  It can be used with caution during breastfeeding but monitoring is required.

Monitoring

As a precaution, monitor the infant for diarrhoea, constipation or skin reactions, and for signs of bruising or bleeding which could be prolonged.

Further information

There is no published evidence of use of clopidogrel during breastfeeding.

Its pharmacokinetic properties, including high protein binding and short half life are likely to limit the amount in breast milk, and its reduced oral bioavailability will limit absorption by the infant.  However, clopidogrel has a metabolite that irreversibly binds to platelets so any that is absorbed by the infant could have a prolonged effect.

The manufacturers state that no side effects have been reported in breastfed infants in a small number of post marketing cases.

Use with caution

There is no published information on the amount of dipyridamole which passes into breast milk although levels are likely to be low.  It can be used with caution during breastfeeding but monitoring is required.

Monitoring

As a precaution, monitor the infant for diarrhoea, vomiting, skin reactions, irritability and for signs of bruising or bleeding.

Further information

There is no published evidence of use of dipyridamole during breastfeeding although the manufacturers state that low levels were found in breast milk.

Its pharmacokinetic properties are likely to limit the amount which passes into breast milk, and absorption by the infant.

No side effects have been reported in breastfed infants.

Dipyridamole can be used therapeutically in infants from one month old.

Use with caution

There is no information on the amount  of prasugrel which passes into breast milk although levels are likely to be low.  It can be used with caution during breastfeeding but monitoring is required.

Monitoring

As a precaution, monitor the infant for skin reactions, and for signs of bruising or bleeding which could be prolonged.

Further information

There is no published evidence of use of prasugrel during breastfeeding.

Its high protein binding is likely to limit the amount excreted into milk.  However, prasugrel irreversibly binds to platelets so any that is absorbed could have a prolonged effect.

No side effects have been reported in breastfed infants

Use with caution

There is no information on the amount of ticagrelor which passes into breast milk although levels are likely to be low.  It can be used with caution during breastfeeding but monitoring is required.

Monitoring

As a precaution, monitor the infant for diarrhoea, vomiting, irritability, or for signs of bruising or bleeding.

Further information

There is no published evidence of use of ticagrelor during breastfeeding.

Its high protein binding is likely to limit the amount excreted into milk, and its low bioavailability will limit absorption by the infant.

No side effects have been reported in breastfed infants.  As ticagrelor has a reversible antiplatelet effect, the duration of any potential side effects relating to bleeding would be less than with an irreversible antiplatelet agent.