Is Cyclophosphamide safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Cyclophosphamide. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
In one 23-day-old infant, neutropenia, thrombocytopenia and a low hemoglobin were possibly caused by cyclophosphamide after 3 days of maternal treatment with cyclophosphamide 6 mg/kg IV daily (total dose 300 mg).[ 9 ] In a 4-month-old, neutropenia was probably caused by cyclophosphamide in a mother 9 days after the last of 6 weekly doses of 800 mg cyclophosphamide intravenously, 2 mg vincristine intravenously and daily doses of 30 mg of prednisolone orally. Neutropenia persisted at least 12 days and was accompanied by a brief episode of diarrhea.[ 10 ] A woman was diagnosed with B-cell lymphoma at 27 weeks of pregnancy. Labor was induced at 34 4/7 weeks and treatment was begun with a standard regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone in unspecified doses on a 21-day cycle, starting on day 2 postpartum. She pumped and discarded her milk and fed her infant donor milk for the first 10 days of each cycle and then breastfed her infant for the remaining 10 days before the next treatment cycle. The 10-day period of breastfeeding abstinence was determined by using about 3 half-lives of vincristine. After completion of 4 cycles of chemotherapy, her infant was reportedly healthy and developing without any complications.[ 11 ]
Effects on milk supply
A case of euprolactinemic galactorrhea was reported in a 55-year-old woman receiving cyclophosphamide for pemphigus vulgaris. One month after starting cyclophosphamide 50 mg daily she experienced fullness in both breasts and bilateral milky nipple discharge. No hormonal abnormalities were found. After cyclophosphamide was discontinued, her symptoms resolved completely and did not recur. Galactorrhea was probably caused by cyclophosphamide.[ 12 ] Telephone follow-up study was conducted on 74 women who received cancer chemotherapy at one center during the second or third trimester of pregnancy to determine if they were successful at breastfeeding postpartum. Only 34% of the women were able to exclusively breastfeed their infants, and 66% of the women reported experiencing breastfeeding difficulties. This was in comparison to a 91% breastfeeding success rate in 22 other mothers diagnosed during pregnancy, but not treated with chemotherapy. Other statistically significant correlations included: 1. mothers with breastfeeding difficulties had an average of 5.5 cycles of chemotherapy compared with 3.8 cycles among mothers who had no difficulties; and 2. mothers with breastfeeding difficulties received their first cycle of chemotherapy on average 3.4 weeks earlier in pregnancy. Of the 56 women who received a cyclophosphamide-containing regimen, 34 had breastfeeding difficulties.[ 13 ]
Levels in milk
Maternal Levels. Unmetabolized cyclophosphamide was qualitatively detected in milk 1, 3, 5 and 6 hours after IV injection of 500 mg of drug in one patient.[ 4 , 5 ] Quantitative determination was not reported. A mother who had been exclusively breastfeeding for 6 months was diagnosed with multiple sclerosis. In preparation for stem cell transplantation, she received intravenous cyclophosphamide 2.8 grams daily for 4 consecutive days. She was also receiving anti-thymocyte immune globulin, methylprednisolone, mesna, and furosemide. She provided milk samples several times on each of the 4 days for analysis of cyclophosphamide. No metabolites, including active metabolites, were measured. Peak cyclophosphamide milk levels occurred at 4 to 5 hours each day. However, the level of exposure was lower on each successive day, presumably because of autoinduction of the drug's metabolism. Peak level ranged from 40.8 mg/L on day 1 to 13.2 mg/L on day 4; the average level ranged from 15.1 mg/L on day 1 to 3.1 mg/L on day 4; and the estimated daily infant dosage ranged from 2.3 mg/kg on day 1 to 0.5 mg/kg on day 4. The weight-adjusted percentage of the maternal dosage ranged from 4.8% on day 1 to 0.9% on day 4.[ 6 ] A woman was diagnosed with B-cell non-Hodgkins lymphoma at 4 months postpartum. She received R-CHOP therapy every 21 days for 6 cycles. It consisted of rituximab 375 mg/sq. m, cyclophosphamide 750 mg/sq. m, doxorubicin 50 mg/sq. m, vincristine 1.4 mg/sq. m (capped at 2 mg) plus prednisone 40 mg/sq. m daily. She also received oral 300 mg of allopurinol daily during the whole therapy course. Milk samples were collected twice daily during the first 3 cycles then once daily for the remaining cycles for a total of 290 samples. Cyclophosphamide was detectable in milk shortly after administration, with the peak milk level of over 1 mg/L occurring shortly after the first dose. The toxic metabolites,4-ketocyclophosphamide, 4-hydroxycyclophosphamide, carboxycyclophosphamide, and
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.