Erenumab use while Breastfeeding

Summary of Use during Lactation

No information is available on the passage of erenumab into breastmilk. Because erenumab is a large protein molecule with a molecular weight of 150,000 Da, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. One 21-month-old infant was breastfed during maternal erenumab therapy without any adverse effects. Until more data become available, erenumab injection should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.

Erenumab is a human immunoglobulin G2 (IgG2) antibody. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G by up to 79%.[1-3] A study of 67 colostrum samples that underwent Holder pasteurization found that IgG amounts decreased by 34 to 40%. Specific IgG subclasses decreased by different amounts, with IgG2 activity decreasing by about 50%.[3] None of the studies measured IgG activity.

Drug Levels

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

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

Effects in Breastfed Infants

A postpartum woman who was nursing her 21-month-old infant twice daily had chronic migraine unresponsive to conventional treatment. Erenumab was begun at a dose of 70 mg (presumably subcutaneously once monthly). The mother noted no adverse effects in the infant over the following 5 months. The infant developed adequately, and each of seven mandatory childhood check-ups was normal. No infections occurred, and no problems with nutrition were noted.[4]

Effects on Lactation and Breastmilk

A review of the database of reports of suspected adverse reactions maintained by the World Health Organization identified one report of an infant who experienced poor feeding during maternal use of erenumab. No further details were provided.[5]

Alternate Drugs to Consider

(Migraine Prophylaxis) Divalproex, Metoprolol, Nortriptyline, Propranolol, Rimegepant, Topiramate, Valproic Acid

References

1.

Koenig A, de Albuquerque Diniz EM, Barbosa SF, et al. Immunologic factors in human milk: The effects of gestational age and pasteurization. J Hum Lact. 2005;21:439–43. [PubMed: 16280560]

2.

Adhisivam B, Vishnu Bhat B, Rao K, et al. Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. J Matern Fetal Neonatal Med. 2019;32:3016–9. [PubMed: 29587541]

3.

Rodríguez-Camejo C, Puyol A, Fazio L, et al. Antibody profile of colostrum and the effect of processing in human milk banks: Implications in immunoregulatory properties. J Hum Lact. 2018;34:137–47. [PubMed: 28586632]

4.

Henze T. Erenumab during breastfeeding. Breastfeed Med. 2019;14:513–4. [PubMed: 31381367]

5.

Noseda R, Bedussi F, Gobbi C, et al. Safety profile of erenumab, galcanezumab and fremanezumab in pregnancy and lactation: Analysis of the WHO pharmacovigilance database. Cephalalgia. 2021;41:789–98. [PubMed: 33435709]

Substance Name

Erenumab

CAS Registry Number

1582205-90-0

Drug Class

Breast Feeding

Lactation

Milk, Human

Antibodies, Monoclonal