A 35-year-old pregnant woman visited our outpatient clinical questioning the safety of once daily 50 mg mercaptopurine (MP) during pregnancy and lactation, which was successfully treating her Crohn's disease. We measured MP and its metabolites in plasma and breast milk and found after 4 hours of intake of MP, no MP or its metabolites in breast milk. We concluded that 4 hours after intake of MP, no exposure of the suckling infant to MP and its metabolites was found while being breastfed.
Get full access to this article
View all access options for this article.
References
1.
HutsonJR, MatlowJN, MorettiME, et al.The fetal safety of thiopurines for the treatment of inflammatory bowel disease in pregnancy. J Obstet Gynaecol, 2013; 33:1–8.
2.
KanisSL, De Lima-KaragiannisA, De BoerNK, et al.Use of thiopurines during conception and pregnancy is not associated with adverse pregnancy outcomes or health of infants at one year in a prospective study. Clin Gastroenterol Hepatol, 2017; 15:1232–1241.
3.
BriggsGG, FreemanRK, TowersCV, et al.Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 11th ed. Lippincott Williams & Wilkins (LWW), 2017. ISBN: 978-1-496-34962-0.
4.
DerijksLJJ, WongDR, HommesDW, et al.Clinical pharmacokinetic and pharmacodynamic considerations in the treatment of inflammatory bowel disease. Clin Pharmacokinet, 2018; 57:1075–1106.
5.
World Health Organization; United Nations Children's Fund. Global Strategy for Infant and Young Child Feeding, 2003.
6.
Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US), 2006.
7.
DervieuxT, BoulieuR. Simultaneous determination of 6-thioguanine and methyl 6-mercaptopurine nucleotides of azathioprine in red blood cells by HPLC. Clin Chem, 1998; 44:551–555.
8.
ChristensenLA, DahlerupJF, NielsenMJ, et al.Azathioprine treatment during lactation. Aliment Pharmacol Ther, 2008; 28:1209–1213.
9.
NguyenDA, NevilleMC. Tight junction regulation in the mammary gland. J Mammary Gland Biol Neoplasia, 1998; 3:233–246.
