IncobotulinumtoxinA use while Breastfeeding

Summary of Use during Lactation

No data exist on the medical use of incobotulinumtoxinA during breastfeeding. However, it is not detectable systemically after intramuscular use, thus excretion into breast milk is considered unlikely. Breastfeeding appears to protect infants against botulism.[1] One infant was safely breastfed during maternal botulism and no botulinum toxin was detectable in the mother's milk or infant. Since the doses used medically are far lower than those that cause botulism, amounts ingested by the infant, if any, are expected to be small and not cause any adverse effects in breastfed infants[2,3] No special precautions are required.

Drug Levels

Maternal Levels. Published information on the medical use of botulin A during breastfeeding was not found as of the revision date.

Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. She was given 2 vials of trivalent botulism antitoxin, 1 intravenously and 1 intramuscularly. A milk sample obtained 3 days after the onset of her illness and 4 hours after administration of botulinum antitoxin had no detectable botulinum toxin nor botulism organisms.[4]

Infant Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. No botulinum toxin was detected in the breastfed infant's blood or stool on the day the mother was admitted to the hospital (3 days after the onset of illness) and no botulism organisms were detected in the infant's stools.[4]

Effects in Breastfed Infants

Published information on the medical use of botulin A during breastfeeding was not found as of the revision date.

A woman developed botulism after ingesting fermented salmon eggs while breastfeeding her 8-month-old breastfed (extent not stated) infant. The infant developed no signs or symptoms of botulism even though she continued to nurse throughout the mother's hospitalization.[4]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Arnon SS, Damus K, Thompson B, et al. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982;100:568-73. [PubMed: 7038077]

2.

Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol 2014;70:417.e1-10. [PubMed: 24528912]

3.

Lee KC, Korgavkar K, Dufresne RG, Jr, Higgins HW, 2nd. Safety of cosmetic dermatologic procedures during pregnancy. Dermatol Surg 2013;39:1573-86. [PubMed: 24164677]

4.

Middaugh J. Botulism and breast milk. N Engl J Med 1978;298:343. [PubMed: 622098]

Substance Name

IncobotulinumtoxinA

CAS Registry Number

93384-43-1

Drug Class

Breastfeeding

Lactation

Milk, Human

Bacterial Toxins

Neuromuscular Agents

Neurotoxins