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Ranibizumab use while Breastfeeding

Drugs containing Ranibizumab: Lucentis

Medically reviewed by Drugs.com. Last updated on Oct 8, 2018.

Ranibizumab Levels and Effects while Breastfeeding

Summary of Use during Lactation

Because ranibizumab is a large protein molecule with a molecular weight of 48,000, 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 infant was breastfed, apparently without noticeable harm, following maternal intravitreal ranibizumab injections. Vascular endothelial growth factor (VEGF) levels in breastmilk were not changed following the injection. Because the breast and neonatal intestine have VEGF receptors, some authors recommend use of intravitreal ranibizumab over bevacizumab, which does appear to depress milk VEGF levels.[1]

Ranibizumab is a human immunoglobulin G1 (IgG1) kappa antibody. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G by up to 79%.[2][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 IgG1 activity decreasing by about 37%.[4] None of the studies measured IgG activity.

Drug Levels

Maternal Levels. A woman was given 3 intravitreal injections of bevacizumab for scar-associated choroidal neovascularization in her left eye. Vascular endothelial growth factor (VEGF) was measured in serum and breastmilk. After the intravitreal injection of bevacizumab, the VEGF level in breastmilk decreased from 13.3 to 8.6 mcg/L over a 2-week period. After changing therapy to ranibizumab therapy, no decrement in breastmilk VEGF was seen during the 42 days following injection.[1]

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

Effects in Breastfed Infants

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

Effects on Lactation and Breastmilk

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

Alternate Drugs to Consider

(Intravitreal) Bevacizumab

References

1. Ehlken C, Martin G, Stahl A, Agostini HT. Reduction of vascular endothelial growth factor a in human breast milk after intravitreal injection of bevacizumab but not ranibizumab. Arch Ophthalmol. 2012;130:1226-7. PMID: 22965611

2. 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. PMID: 16280560

3. 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. 2018;1-4. PMID: 29587541

4. Rodriguez-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. PMID: 28586632

Ranibizumab Identification

Substance Name

Ranibizumab

CAS Registry Number

347396-82-1

Drug Class

Breast Feeding

Lactation

Antibodies, Monoclonal

Angiogenesis Inhibitors

Administrative Information

LactMed Record Number

1012

Disclaimer

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Further information

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