Breastfeeding and Tacrolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants
Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2013-04, Vol.8 (4), p.563-567 |
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| creator | Bramham, Kate Chusney, Gary Lee, Janet Lightstone, Liz Nelson-Piercy, Catherine |
| description | Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.
An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography-tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.
All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82-0.88; P |
| doi_str_mv | 10.2215/CJN.06400612 |
| format | Article |
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An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography-tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.
All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82-0.88; P<0.001). Breast-fed infants did not have higher tacrolimus levels compared with bottle-fed infants (median 1.3 μg/L [range, 0.0-4.0] versus 1.0 μg/L [range, 0.0-2.3], respectively; P=0.91). Maximum estimated absorption from breast milk is 0.23% of maternal dose (weight-adjusted).
Ingestion of tacrolimus by infants via breast milk is negligible. Breastfeeding does not appear to slow the decline of infant tacrolimus levels from higher levels present at birth. Women taking tacrolimus should not be discouraged from breastfeeding if monitoring of infant levels is available.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.06400612</identifier><identifier>PMID: 23349333</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Adult ; Bottle Feeding - statistics & numerical data ; Breast Feeding - statistics & numerical data ; Cohort Studies ; Female ; Humans ; Immunosuppression - adverse effects ; Immunosuppressive Agents - adverse effects ; Immunosuppressive Agents - analysis ; Immunosuppressive Agents - pharmacokinetics ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases - chemically induced ; Infant, Newborn, Diseases - epidemiology ; Infant, Newborn, Diseases - prevention & control ; Lactation ; Milk, Human - chemistry ; Milk, Human - immunology ; Original ; Pregnancy ; Pregnancy Complications - drug therapy ; Risk Factors ; Tacrolimus - adverse effects ; Tacrolimus - analysis ; Tacrolimus - pharmacokinetics</subject><ispartof>Clinical journal of the American Society of Nephrology, 2013-04, Vol.8 (4), p.563-567</ispartof><rights>Copyright © 2013 by the American Society of Nephrology 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c334t-e77f086a21ca52fce3a69303d912ee418360574040aee6094d34a29ab56a21d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613954/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613954/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23349333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bramham, Kate</creatorcontrib><creatorcontrib>Chusney, Gary</creatorcontrib><creatorcontrib>Lee, Janet</creatorcontrib><creatorcontrib>Lightstone, Liz</creatorcontrib><creatorcontrib>Nelson-Piercy, Catherine</creatorcontrib><title>Breastfeeding and Tacrolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.
An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography-tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.
All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82-0.88; P<0.001). Breast-fed infants did not have higher tacrolimus levels compared with bottle-fed infants (median 1.3 μg/L [range, 0.0-4.0] versus 1.0 μg/L [range, 0.0-2.3], respectively; P=0.91). Maximum estimated absorption from breast milk is 0.23% of maternal dose (weight-adjusted).
Ingestion of tacrolimus by infants via breast milk is negligible. Breastfeeding does not appear to slow the decline of infant tacrolimus levels from higher levels present at birth. Women taking tacrolimus should not be discouraged from breastfeeding if monitoring of infant levels is available.</description><subject>Adult</subject><subject>Bottle Feeding - statistics & numerical data</subject><subject>Breast Feeding - statistics & numerical data</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Immunosuppression - adverse effects</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Immunosuppressive Agents - analysis</subject><subject>Immunosuppressive Agents - pharmacokinetics</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infant, Newborn, Diseases - chemically induced</subject><subject>Infant, Newborn, Diseases - epidemiology</subject><subject>Infant, Newborn, Diseases - prevention & control</subject><subject>Lactation</subject><subject>Milk, Human - chemistry</subject><subject>Milk, Human - immunology</subject><subject>Original</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - drug therapy</subject><subject>Risk Factors</subject><subject>Tacrolimus - adverse effects</subject><subject>Tacrolimus - analysis</subject><subject>Tacrolimus - pharmacokinetics</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkM1PwkAQxTdGI4jePJuePFncz5Z6MBEiikE9iIm3zdBOYUnZkt2i8b-3UCF6mpnM773JPELOGe1yztT14OmlSyNJacT4AWkzpVSYUPVxuO8la5ET7xeUSim4OiYtLoRMhBBtMuk7BF_liJmxswBsFkwgdWVhlmt_E7yhM1AEz6U1Vek2hLFBIwmHmG35fllVBW7Hkc3BVv6UHOVQeDz7rR3yPryfDB7D8evDaHA3DtP6fhViHOe0FwFnKSiepyggSgQVWcI4omQ9EVEVSyopIEY0kZmQwBOYqo0mi0WH3Da-q_V0iVmKtnJQ6JUzS3DfugSj_2-smetZ-alFxESiZG1w1RjUH3vvMN9rGdWbdHWdrt6lW-MXf-_t4V2cNXDZAHMzm38Zh9ovoShqnOt0Ad72tNQqEuIHO9-C6w</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Bramham, Kate</creator><creator>Chusney, Gary</creator><creator>Lee, Janet</creator><creator>Lightstone, Liz</creator><creator>Nelson-Piercy, Catherine</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20130401</creationdate><title>Breastfeeding and Tacrolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants</title><author>Bramham, Kate ; Chusney, Gary ; Lee, Janet ; Lightstone, Liz ; Nelson-Piercy, Catherine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c334t-e77f086a21ca52fce3a69303d912ee418360574040aee6094d34a29ab56a21d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Bottle Feeding - statistics & numerical data</topic><topic>Breast Feeding - statistics & numerical data</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Immunosuppression - adverse effects</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Immunosuppressive Agents - analysis</topic><topic>Immunosuppressive Agents - pharmacokinetics</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infant, Newborn, Diseases - chemically induced</topic><topic>Infant, Newborn, Diseases - epidemiology</topic><topic>Infant, Newborn, Diseases - prevention & control</topic><topic>Lactation</topic><topic>Milk, Human - chemistry</topic><topic>Milk, Human - immunology</topic><topic>Original</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - drug therapy</topic><topic>Risk Factors</topic><topic>Tacrolimus - adverse effects</topic><topic>Tacrolimus - analysis</topic><topic>Tacrolimus - pharmacokinetics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bramham, Kate</creatorcontrib><creatorcontrib>Chusney, Gary</creatorcontrib><creatorcontrib>Lee, Janet</creatorcontrib><creatorcontrib>Lightstone, Liz</creatorcontrib><creatorcontrib>Nelson-Piercy, Catherine</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bramham, Kate</au><au>Chusney, Gary</au><au>Lee, Janet</au><au>Lightstone, Liz</au><au>Nelson-Piercy, Catherine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Breastfeeding and Tacrolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>8</volume><issue>4</issue><spage>563</spage><epage>567</epage><pages>563-567</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.
An observational cohort study was performed in two tertiary referral high-risk obstetric medicine clinics. Fourteen women taking tacrolimus during pregnancy and lactation, and their 15 infants, 11 of whom were exclusively breast-fed, were assessed. Tacrolimus levels were analyzed by liquid chromatography-tandem mass spectrometry. Samples from mothers and cord blood were collected at delivery and from mothers, infants, and breast milk postnatally where possible.
All infants with serial sampling had a decline in tacrolimus level, which was approximately 15% per day (ratio of geometric mean concentrations 0.85; 95% confidence interval, 0.82-0.88; P<0.001). Breast-fed infants did not have higher tacrolimus levels compared with bottle-fed infants (median 1.3 μg/L [range, 0.0-4.0] versus 1.0 μg/L [range, 0.0-2.3], respectively; P=0.91). Maximum estimated absorption from breast milk is 0.23% of maternal dose (weight-adjusted).
Ingestion of tacrolimus by infants via breast milk is negligible. Breastfeeding does not appear to slow the decline of infant tacrolimus levels from higher levels present at birth. Women taking tacrolimus should not be discouraged from breastfeeding if monitoring of infant levels is available.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>23349333</pmid><doi>10.2215/CJN.06400612</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult Bottle Feeding - statistics & numerical data Breast Feeding - statistics & numerical data Cohort Studies Female Humans Immunosuppression - adverse effects Immunosuppressive Agents - adverse effects Immunosuppressive Agents - analysis Immunosuppressive Agents - pharmacokinetics Infant Infant, Newborn Infant, Newborn, Diseases - chemically induced Infant, Newborn, Diseases - epidemiology Infant, Newborn, Diseases - prevention & control Lactation Milk, Human - chemistry Milk, Human - immunology Original Pregnancy Pregnancy Complications - drug therapy Risk Factors Tacrolimus - adverse effects Tacrolimus - analysis Tacrolimus - pharmacokinetics |
| title | Breastfeeding and Tacrolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants |
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