By Lauraanne Hirschler, BS, OMS4 with the help of Casey Rosen-Carole, MD, MPH, MSED, FABM and Rogelio Perez-D’Gredorio, MD, MS
As an infant, I received the gift of life in the form of a liver transplant. Growing up, I remember taking a multitude of drugs that have just become part of my daily life. As the years continued, my immune system became stronger, transplant controls became longer and longer in the meantime. As the years went by, I found myself taking an extremely low dose of an immunosuppressive called Tacrolimus. Inspired by my personal trip as a patient, I went to the medical school with a passion to take care of patients, as my health care providers had taken care of me. During my training as a doctor, I began to be interested in how the drugs a person needs to take can affect pregnancy and breastfeeding.
With this interest in women’s health, I followed a rotation in breastfeeding and lactation. I worked along with a stunning team of specialists to help patients achieve the goals of breastfeeding. I reviewed the drugs prescribed by new mothers to make sure they tackle mom’s medical needs and also have the lowest risk of affecting their growing baby. With the desire for my own family, I wanted to know more about taking tacrolimus while breastfeeding. I saw firsthand how beneficial breastfeeding she was and wondered if taking this drug many times a day would give any risk to my growing baby. Could i ever breastfeed?
Tacrolimus (Prograf®, Envarsus®, Astagraf®) is a drug used by transplantation, such as liver, kidneys or heart transplants. Helps prevent the body to reject the new organ. It is usually taken as a pill, but can also be taken as IV, as liquid or applied to the skin for situations such as eczema.
I have found that research studies have shown promising evidence that breastfeeding when taking tacrolimus is probably not worried about breastfeeding children. A study looked at a mom who took Tacrolimus twice a day. After a dose, scientists checked her breast milk and found a very small amount of tacrolimus in milk. The amount was much lower than that given directly to the babies needed by the drug.
One study included a patient with a heart transplant of breastfeeding who took tacrolimus throughout her pregnancy and after birth. When her baby took a month, blood levels tacrolimus were measured both on mom and baby. This baby’s tacrolimus levels were extremely low.
Another study examined three exclusively breastfeeding infants and a partially lactating infant whose mothers took the tacrolimus mouth. Researchers measured quantities of tacrolimus in these infants between 15-27 days of life. None of the babies had detectable levels of tacrolimus in their blood.
One of the largest studies was carried out by the National Transplant Pregnancy Register. She looked at 68 mothers who had liver or kidney transplants. The study was followed by 83 babies, a few for 16 years. None of the babies had medical problems related to the use of Tacrolimus by their mother.
Tacrolimus is also used in cream form for conditions such as eczema. The good news is that the risk of this cream that affects a breastfeeding baby is very low, because only a small amount of cream enters the mom’s body. However, if the cream is applied to the nipple, it should be cleaned before baby nurses. If topical nipples are required, some specialists recommend pimecrolimus cream over tacrolimus because it does not contain paraffin. Other treatments such as hydrocortisone ointments are best studied and are usually used first.
Breastfeeding when taking tacrolimus has been shown to be a low risk for breastfeeding babies. Since breast milk has many health benefits for babies, healthcare providers recommend mothers who take tacrolimus to breastfeed their babies. As with any health status, a discussion with the healthcare provider is required to weigh the risks and benefits to determine the right choice for your family.
After learning more about breastfeeding safety while taking tacrolimus, I feel empowered and encouraged to breastfeed my future children, especially because breast milk is so healthy and nutritious for babies.
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