Is It Safe for Me to Breastfeed While on My IBD Medications? Safety of Lactation and IBD Medications

Abstract

Most medications used to treat inflammatory bowel diseases (IBDs) including ulcerative colitis and Crohn’s disease are safe to continue while breastfeeding. Medications including 5-aminosalicylic acids (5-ASAs), thiopurines, and anti-tumor necrosis factor medications are excreted in minimal concentrations in breast milk and cause little to no known adverse side effects in the breastfed infant. An important exception to this rule is methotrexate, which is pregnancy category X and should not be used in pregnant or breastfeeding mothers. Also, several antibiotics sometimes used in the treatment of IBD, including metronidazole and ciprofloxacin, can be excreted into the breast milk, and long-term use should be avoided if possible. Additionally, some experts recommend that lactating mothers withhold breastfeeding for 4 h after taking a dose of a thiopurine agent (azathioprine or 6-mercaptopurine) to help decrease infant exposure to this medication, although long-term studies on this medication have failed to show any increased risk of infections in breastfed infants of mothers taking azathioprine. Anti-tumor necrosis factor agents (infliximab, adalimumab, and certolizumab) have little to no excretion in breast milk and are likely compatible with breastfeeding. Finally, although there is little data available on the safety of breastfeeding with anti-integrin antibody agents (natalizumab, vedolizumab), they may be detected in breast milk and caution should be used when administering to nursing women.