Is Rivaroxaban safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Rivaroxaban. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
A 38-year-old woman with antiphospholipid syndrome began rivaroxaban 15 mg (0.19 mg/kg) daily at 5 days postpartum for prophylaxis of deep vein thrombosis. She partially breast-fed her infant (at least 50%). No apparent evidence of bleeding was noted in the infant at 1- and 3-month check-ups and development was normal at 18 months of age.[ 4 ] Two mothers received rivaroxaban 15 mg (0.22 and 0.25 mg/kg) daily beginning 3 days postpartum for prophylaxis of deep vein thrombosis. At 3 months postpartum, their infants continued to be breastfed (extent not stated) and had no health problems or bleeding events.[ 7 ]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. A 40-year-old woman developed bilateral pulmonary embolism and peripartum cardiomyopathy following cesarean section. She initially received enoxaparin, but was switched to oral rivaroxaban 15 mg twice daily after 2 days. On day 3 of rivaroxaban, complete milk collections from both breasts were obtained before and at 3, 6, and 10 hours after the morning dose. Blood samples were taken at the same times. The authors calculated that a fully breastfed infant would receive 2.4 mcg/kg over the 10-hour period, which would be 1.3% of the maternal weight-adjusted dosage.[ 3 ] A 38-year-old woman with antiphospholipid syndrome began rivaroxaban 15 mg (0.19 mg/kg) daily at 5 days postpartum for prophylaxis of deep vein thrombosis. On two separate days, 7 samples of milk were taken over a 24-hour period. Values were similar at the same times on each day. A mean peak value of 53.9 mcg/L occurred at 6 hours after the dose and the average milk concentration was 22.7 mcg/L. The half-life in milk was 4.7 hours. The estimated daily dose that a fully breastfed infant would receive was 3.4 mcg/kg daily, which corresponded to 1.8% of the maternal weight-adjusted dosage.[ 4 ] Two postpartum women were prescribed rivaroxaban, one for stroke and the other for a pulmonary embolism. Each began therapy with 15 mg twice daily for 21 days, then 20 mg daily. Both patients provided several steady-state milk samples over the dosage interval during each regimen. After the 15 mg dose, a mean peak value of 300 mcg/L occurred 1 hour after the dose, and the average milk concentration was 160 mcg/L. The estimated daily dose that a fully breastfed infant would receive was 10 mcg/kg every 12 hours, which corresponded to 5% of the maternal weight-adjusted dosage. After the 20 mg dose, the mean peak value of 260 mcg/L occurred 2 hours after the dose and the average milk concentration was 70 mcg/L. The estimated daily dose that a fully breastfed infant would receive was 10 mcg/kg daily, which
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.