I currently take the blood thinner lovenox in injection form ( I am 27 weeks pregnant.) My doctor said that I can take cumadin once the baby is born for the 6 postpartem weeks. I thought cumadin was not healthy for pregnancy or breast feeding. Does anyone have any idea? I was thinking I would continue the lovenox for those 6 weeks. Most drugs that have to be injected are perfectly safe to take during breastfeeding because even if they were to appear in milk they aren't digestable. After all if you could take them orally then you wouldn't be injecting it now would you?
So you can continue taking the lovenox but the doctor probably assumes you'd rather switch to a pill like coumadin. Neither is of any risk to the baby once its born, one is too big to enter breastmilk and the other can't be absorbed by the digestive tract.
If you want to discuss this with someone more qualified than random people on the internet you can call motherisk: (416) 813-6780 Monday to Friday 9-5 EST
http://www.kellymom.com/newman/09a-drugs...
Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society. And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother鈥檚 milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping.
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Most drugs are safe if:
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# They are not absorbed from the stomach or intestines. These include many, but not all, drugs given by injection. Examples are gentamicin (and other drugs in this family of antibiotics), heparin, interferon, local anaesthetics, omperazole.
# They are not excreted into the milk. Some drugs are just too big to get into the milk. Examples are heparin, interferon, insulin, infliximab (Remicade), etanercept (Enbrel).
http://safefetus.com/DrugDetail.asp?Drug...
Generic Name Enoxaparin
Trade Name Lovenox
Manufacturer
Risk Category
B
* Controlled studies done on animals in reproduction do not indicate risk to the fetus.
* No adequate and well-controlled studies done on pregnant women.
FDA Pregnancy Risk Categories
Place (not click) your mouse cursor over the bold words in the text below to receive description
Indication
* Low-molecular weight heparin, anti-coagulant.
Fetal Risk
* Does not cross the placenta.
* No bleeding complications in the fetus or mothers exposed.
* Safe even with epidural anesthesia.
* No effect on bone mineral density in women exposed.
Breast Feeding
* Negligible passage into milk.
http://www.safefetus.com/DrugDetail.asp?...
Generic Name Warfarin (nicoumalone; dicoumarol)
Trade Name Coumadin
Manufacturer
Risk Category
X
* Positive evidence of human fetal risk exists.
* Potential benefits may warrant use of the drug in pregnant women despite potential risks (e.g. life threatening situations or serious illness).
* Studies in animals and/or humans have demonstrated fetal abnormalities.
* Fetal risk involved in use of drug, clearly outweighs potential benefit.
* Contraindicated in women who are or may become pregnant. Don鈥檛 use.
FDA Pregnancy Risk Categories
Place (not click) your mouse cursor over the bold words in the text below to receive description
Indication
* Oral anticoagulant.
Fetal Risk
* Certain congenital malformations were associated with warfarin use in the first trimester; including nasal hypoplasia, stippled epiphyseal calcifications, and central nervous system abonormalities.
* Increased incidence of abortion and stillbirths.
Breast Feeding
* Excreted in breast milk.
* Problems have not been documented yet.
http://toxnet.nlm.nih.gov/cgi-bin/sis/se...
Drug Levels and Effects:
Summary of Use during Lactation:
Although heparin itself has not been studied, low molecular weight heparins (e.g., dalteparin, enoxaparin) are not excreted into breastmilk in clinically relevant amounts. Because heparin has an even higher molecular weight of 3000 to 30,000 daltons, it would not be expected to be absorbed from breastmilk by the infant. No special precautions are required.
Drug Levels:
Maternal Levels. Although it is frequently stated that heparin does not pass into breastmilk because of its high molecular weight, no studies have measured heparin levels or activity in human milk. However, since the low molecular weight heparin enoxaparin is not found in milk, it is unlikely that the larger heparin molecule passes into milk. Additionally, any heparin in milk would not be absorbed from the infant's gastrointestinal tract.
Infant Levels. Relevant published information was not found as of the revision date.
Warfarin
CASRN: 81-81-2
For other data, click on the Table of Contents
Drug Levels and Effects:
Summary of Use during Lactation:
Because of the very low milk levels with warfarin doses up to 12 mg daily, amounts ingested by the infant are small. No adverse reactions in breastfed infants have been reported from maternal warfarin use during lactation. There is a consensus that maternal warfarin therapy during breastfeeding poses little risk to the breastfed infant.[1][2][3]
Drug Levels:
Maternal Levels. Warfarin was not detected (<25 mcg/L) 4 hours after a dose in the breastmilk of 13 mothers who were 3 to 12 days postpartum and anticoagulated with warfarin in doses of 2 to 12 mg daily in one study.[4]
Warfarin activity was also not detected in the milk of 2 anticoagulated women (warfarin dose unspecified) in a second report.[5]
Infant Levels. No warfarin activity was detected in the plasma of any of 7 infants in whom it was measured. Measures of anticoagulation were within normal limits in all infants tested.[5] Get a second opinion however if your doctor says it is ok then it should be. I would get a second opinion though from another doctor just to be on the safe side. Good luck! If your Dr says it is fine then it is fine. You trusted your Dr to take you through your pregnancy. Why do you not trust him now? |
