Document Detail


Breastfeeding and tacrolimus: serial monitoring in breast-fed and bottle-fed infants.
MedLine Citation:
PMID:  23349333     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography-tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.
RESULTS: All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82-0.88; P<0.001). Breast-fed infants did not have higher tacrolimus levels compared with bottle-fed infants (median 1.3 μg/L [range, 0.0-4.0] versus 1.0 μg/L [range, 0.0-2.3], respectively; P=0.91). Maximum estimated absorption from breast milk is 0.23% of maternal dose (weight-adjusted).
CONCLUSIONS: Ingestion of tacrolimus by infants via breast milk is negligible. Breastfeeding does not appear to slow the decline of infant tacrolimus levels from higher levels present at birth. Women taking tacrolimus should not be discouraged from breastfeeding if monitoring of infant levels is available.
Authors:
Kate Bramham; Gary Chusney; Janet Lee; Liz Lightstone; Catherine Nelson-Piercy
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-01-24
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  8     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-08     Completed Date:  2013-09-30     Revised Date:  2014-04-10    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  563-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Bottle Feeding / statistics & numerical data*
Breast Feeding / statistics & numerical data*
Cohort Studies
Female
Humans
Immunosuppression / adverse effects
Immunosuppressive Agents / adverse effects,  analysis,  pharmacokinetics
Infant
Infant, Newborn
Infant, Newborn, Diseases / chemically induced,  epidemiology*,  prevention & control
Lactation
Milk, Human / chemistry,  immunology
Pregnancy
Pregnancy Complications / drug therapy*
Risk Factors
Tacrolimus / adverse effects*,  analysis,  pharmacokinetics
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; WM0HAQ4WNM/Tacrolimus
Comments/Corrections
Comment In:
Expert Rev Clin Immunol. 2013 Jul;9(7):623-6   [PMID:  23899232 ]

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