Summary of use during lactation
Information from one patient indicates that the drug may be used in nursing mothers; however, more data are needed. Since glycosylated belatacept has a molecular weight of 92,300 Da, it is unlikely to appear in milk. The manufacturer recommends avoiding nursing if belatacept is given. Because the drug’s half-life is 8 to 10 days, it may be more than a month after a dose before the drug is absent from breastmilk. Waiting for at least 2 weeks postpartum to resume therapy may minimize transfer to the infant.[1]
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
A mother with a liver transplant was maintained on belatacept 10 mg/kg monthly, slow-release tacrolimus (Envarsus and Veloxis) 2 mg daily, azathioprine 25 mg daily, and prednisone 2.5 mg daily. She breastfed her infant for a year (extent not stated). The infant’s growth and cognitive milestones were normal.[2] In a case series from the Transplant Pregnancy Registry International of women who received belatacept during pregnancy and postpartum, 5 women with kidney transplants breastfeed their 7 children while continuing belatacept infusions with no reports of problems breastfeeding or issues in the children. The duration and extent of breastfeeding was not reported in 4 instances, but in the other 3, the durations were 1 month, 2 months, and 4 weeks exclusive breastfeeding, followed by partial breastfeeding.[3] A review of the Transplant Pregnancy Registry International database from 1999 to 2024 found that 6 mothers with transplants had breastfed their infants for at least 4 weeks while taking belatacept.[4] These 6 probably included the 5 women reported above.
Effects on lactation and breastmilk
Relevant published information was not found as of the revision date.
Alternative drugs to consider
Azathioprine, Cyclosporine, Tacrolimus
Source: Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, NCBI Bookshelf. Check LactMed for the most recent revision.
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