Auranofin and Breastfeeding

Summary of use during lactation

Excretion of gold into milk after auranofin has not been studied. Case reports with other gold salts indicate that gold appears in milk in small quantities and at least a little of it is absorbed because it is detectable in the infant's urine. No convincing cases of toxicity have been reported. Opinions of authors of review articles vary from recommending avoidance to allowing use.[1-5] Monitoring for possible adverse effects in the breastfed infant would seem prudent.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Four infants reportedly have been breastfed during maternal gold therapy (including gold sodium thiomalate and gold aurothioglucose).[6-9] Transient facial edema occurred in an 18-month-old infant, 3 months after the mother's treatment stopped.[6] The reaction was possibly due to gold in the mother's milk ingested by the infant.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Rheumatoid Arthritis) Etanercept, Gold Sodium Thiomalate, Hydroxychloroquine, Infliximab, Methotrexate, Penicillamine, Sulfasalazine

References

1. Østensen M. Treatment with immunosuppressive and disease modifying drugs during pregnancy and lactation. Am J Reprod Immunol 1992;28:148-521285866 PubMed
2. Rayburn WF. Connective tissue disorders and pregnancy. Recommendations for prescribing. J Reprod Med 1998;43:341-99583066 PubMed
3. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy and lactation. Arch Intern Med 2000;160:610-910724046 PubMed
4. Ramsey-Goldman R, Schilling E. Optimum use of disease-modifying and immunosuppressive antirheumatic agents during pregnancy and lactation. Clin Immunother 1996;5:40-58.doi:10.1007/BF03259314 PubMed
5. Brooks PM, Needs CJ. Antirheumatic drugs in pregnancy and lactation. Baillieres Clin Rheumatol 1990;4:157-712282661 PubMed
6. Bell RA, Dale IM. Gold secretion in maternal milk. Arthritis Rheum 1976;19:1374826260 PubMed
7. Sørensen SS. Pharmacodynamic examination of patients treated with gold preparations. Nord Med 1970;84:15085494985 PubMed
8. Blau SP. Metabolism of gold during lactation. Arthritis Rheum 1973;16:777-84757877 PubMed
9. Bennett PN, Humphries SJ, Osborne JP, et al. Use of sodium aurothiomalate during lactation. Br J Clin Pharmacol 1990;29:777-92116162 PubMed