Epoetin Alfa use while Breastfeeding
Drugs containing Epoetin Alfa: Procrit, Epogen
Epoetin Alfa Levels and Effects while Breastfeeding
Summary of Use during Lactation
The excretion of exogenous epoetin alfa (biosynthetic erythropoietin) in breastmilk or its effects on breastfed infants have not been studied. However, erythropoietin is a normal component of human milk. Some authors have hypothesized that erythropoietin in milk might help maintain the integrity of the lining of the mammary epithelium and the infant gastrointestinal tract, thereby reducing the risk of mother-to-child transmission of HIV infection (MTCT).[1] A case-control study in Tanzania supports the protective role of erythropoietin in breastmilk against MTCT.[2] Erythropoietin might also have a modest beneficial effect on the infant's red cell production.[3] No special precautions are required during breastfeeding.
Drug Levels
Maternal Levels. Relevant published information on exogenous administration of epoetin alfa was not found as of the revision date. However, breastmilk normally contains erythropoietin. Erythropoietin concentrations in human milk are in the range of approximately 4 to 5 units/L in the first 1 to 2 months postpartum and increase to 20 to 40 units/L by the third month and to 100 to 150 units/L by 12 months.[1] A study on pasteurization of breastmilk found that the erythropoietin concentration in breastmilk dropped from 1.9 international units/L before pasteurization to 0.5 international units/L after pasteurization.[4]
Infant Levels. Published information on absorption of epoetin alfa from breastmilk was not found as of the revision date. However, several studies in which oral doses of epoetin alfa and other recombinant forms of erythropoietin were given to preterm infants found that epoetin is absorbed to a small extent. Increases in hematocrit in infants treated with oral epoetin alfa have been small to negligible.[3][5][6][7][8][9] However, one study found that hospitalized preterm infants taking enteral feedings and given 400 units daily of recombinant human erythropoietin by mouth with ferrous sulfate had higher reticulocyte counts and serum erythropoietin concentrations upon hospital discharge than control infants given only ferrous sulfate.[3]
Effects in Breastfed Infants
Enhancement of gastrointestinal tract maturation has been proposed as a function of erythropoietin in breastmilk.[1][10]
Possible Effects on Lactation
In small studies, epoetin alfa administration decreased serum prolactin in patients with amylotrophic lateral sclerosis,[11] but had no effect in normal subjects or in patients with renal failure undergoing chronic ambulatory peritoneal dialysis.[12][13] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
References
1. Semba RD, Juul SE. Erythropoietin in human milk: physiology and role in infant health. J Hum Lact. 2002;18:252-61. PMID: 12192960
2. Arsenault JE, Webb AL, Koulinska IN et al. Association between breast milk erythropoietin and reduced risk of mother-to-child transmission of HIV. J Infect Dis. 2010;202:370-3. PMID: 20557236
3. Pasha YZ, Ahmadpolir-Kacho M, Hajiahmadi M, Hosseini M. Enteral erythropoietin increases plasma erythropoietin level in preterm infants: a randomized controlled trial. Indian Pediatr. 2008;45:25-8. PMID: 18250501
4. Untalan PB, Keeney SE, Rivera A, Goldman AS. The effect of pasteurization on cytokines in human milk. J Invest Med. 2007;55 (Suppl S):S288. Abstract.
5. Calhoun DA, Christensen RD. Hematopoietic growth factors in neonatal medicine: the use of enterally administered hematopoietic growth factors in the neonatal intensive care unit. Clin Perinatol. 2004;31:169-82. PMID: 15183665
6. Ballin A, Bilker-Reich A, Arbel E et al. Erythropoietin, given enterally, stimulates erythropoiesis in premature infants. Lancet. 1999;353:1849. Letter. PMID: 10359412
7. Juul SE. Enterally doses recombinant human erythropoietin does not stimulate erythropoiesis in neonates. J Pediatr. 2003;143:321-6. PMID: 14517513
8. Juul SE, Cristensen RD. Absorption of enteral recombinant human erythropoietin by neonates. Ann Pharmacother. 2003;37:782-6. PMID: 12773061
9. Britton JR, Christensen RD. Enteral administration of recombinant erythropoietin to preterm infants. J Perinatol. 1995;15:281-3. PMID: 8558334
10. Miller M, Iliff P, Stoltzfus RJ, Humphrey J. Breastmilk erythropoietin and mother-to-child HIV transmission through breastmilk. Lancet. 2002;360:1246-8. PMID: 12401271
11. Tokgoz B, Utas C, Dogukan A et al. Influence of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid axis in patients undergoing CAPD. Ren Fail. 2002;24:315-23. PMID: 12166698
12. Bernini GP, Mariotti F, Brogi G et al. Effects of erythropoietin administration on prolactin secretion in normal subjects. Nephron. 1993;65:522-6. PMID: 8302403
13. Markianos M, Kosmidis ML, Sfagos C. Reductions in plasma prolactin during acute erythropoietin administration. Neuro Endocrinol Lett. 2006;27:355-8. PMID: 16816832
Epoetin Alfa Identification
Substance Name
CAS Registry Number
113427-24-0
Drug Class
- Colony-Stimulating Factors
- Hematinics
- Hematopoietic Cell Growth Factors
Administrative Information
LactMed Record Number
496
Information from the National Library of Medicine's LactMed Database.
Last Revision Date
2011-01-04
Disclaimer
Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
See Also...
- Epoetin alfa use during Pregnancy
- Epoetin Alfa Consumer Information
- Breastfeeding Support Group
- Safe Medications during Breastfeeding
- Medicine use while Breastfeeding
- Medicine use during Pregnancy
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