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In Tso et al's article, it is stated that females on adalimumab should not breastfeed until at least 5 months after the last treatment, according to the manufacturer's information. However the majority of manufacturers have recently updated their information and now state that adalimumab can be used during breastfeeding.
The NICE Guideline PH11 Maternal and Child Nutrition1 recommends supplementary sources of information should be consulted regarding the prescribing of drugs to breastfeeding mothers, and that the BNF should only be used as a ‘guide’.
The BNF contains little quantitative data on which to make informed decisions. The Summary of Product Characteristics of the vast majority of drugs recommends they are not used during lactation. This does not imply risk, more that the manufacturers are not required to take responsibility.2
I consulted UKDILAS (UK Drugs in Lactation Advisory Service - www.sps.nhs.uk/articles/ukdilas) and Lactmed, both specialist sources of information for prescribing in lactation. Lactmed states: "Limited information indicates that maternal adalimumab injections produce low levels in breastmilk and do not adversely affect the nursing infant. Because adalimumab is a large protein molecule, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Most experts fe...
Show MoreCompeting Interests: None declared.