Is OnabotulinumtoxinA safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about OnabotulinumtoxinA. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
One mother breastfed her infant while she was experiencing toxicity from botulism poisoning. She breastfed her 2-month-old infant. Although the mother died, the infant had no symptoms.[ 6 ] A woman developed botulism after ingesting fermented salmon eggs while breastfeeding her 8-month-old breastfed (extent not stated) infant. The infant developed no signs or symptoms of botulism even though she continued to nurse throughout the mother's hospitalization.[ 3 ]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. She was given 2 vials of trivalent botulism antitoxin, 1 intravenously and 1 intramuscularly. A milk sample obtained 3 days after the onset of her illness and 4 hours after administration of botulinum antitoxin had no detectable botulinum toxin nor botulism organisms.[ 3 ] Four women undergoing cosmetic procedures were injected with doses ranging from 40 to 92 units of onabotulinumtoxinA. Milk samples were taken at baseline and 1, 3 and 5 hours after the injections. Two women had undetectable ( 46 ng/L) levels in all samples after receiving 54 and 92 units. Two other women who received 40 and 46 units had peak milk levels of 422 ng/L and 747 ng/L, respectively.[ 4 ] In a preprint, 3 women were reported who received onabotulinumtoxinA at 3 sites for facial cosmetic procedures for a total dose of 64 units. They were instructed to express 200 mL of breastmilk before treatment and 1, 6, 24, 36, 48, and 72 hours after treatment using a manual pump. In addition, milk samples were collected at 5, 6, 7, 10, and 11 days, 2 months, 4 months, and 5 months after the injections. The highest observed concentration was 33.4 ng/L in in one woman 4 days after the injection. In another woman, the highest concentration occurred 3 days after the injection. After the first week, milk concentrations in one woman decreased to a low of 6.9 ng/L at 11 days, before another peak of 26.6 ng/L at 2 months after the injections. If the highest concentration and a dose of 150 mL/kg daily breastmilk intake are used, a breastfed infant would receive a maximum of 5 ng/kg of botulinum toxin A orally per day, which is far below the dose of 12 to 25 units/kg given by injection to children with spastic cerebral palsy.[ 5 ] Infant Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. No botulinum tox
Alternatives LactMed lists
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.