Can mothers breast feed while taking azathioprine?

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Original article by: Peter Golightly

Publisher: Trent Medicines Information Service

Keywords: Azathioprine; Mercaptopurine; Breastfeeding; Breast milk; Lactation;

Date published: 18/03/2011 15:41

Review date: 28/02/2013 14:00

Summary

by: Peter Golightly

Azathioprine passes into breast milk in small quantities. At the highest recorded level of 6-MP in breast milk (50 micrograms/litre) an infant consuming 150ml/kg breast milk each day (international standard [4]) would ingest 7.5micrograms/kg bodyweight of 6-MP (equivalent to 12.2 micrograms/kg bodyweight azathioprine). The recommended daily dose of azathioprine for a 1 month old infant is 1–3 mg/kg bodyweight daily [20].
The evidence available suggests that azathioprine, in normal therapeutic doses in the mother, is compatible with breastfeeding in infants who are full-term and healthy and with no compromised immune system.
It would, however, be advisable to monitor infant blood counts for signs of immunosuppression if azathioprine is used. The frequency and duration of this monitoring should be a clinical decision based on several factors including dose of azathioprine, frequency of breast feeding, age and health of the infant.