Summary of use during lactation
Deferasirox appears to pass into milk very poorly. Although Australian guidelines recommend against breastfeeding during deferasirox treatment,[1] these were published before a case report of an infant being safely breastfed by a mother with beta-thalassemia receiving deferasirox and finding of no drug in breastmilk.[2] However, since little published information is available on the use of deferasirox during breastfeeding, monitoring of the infant's serum iron is recommended.
Drug levels in milk and infant serum
Maternal Levels. A woman with beta-thalassemia was started on deferasirox 2250 mg (35 mg/kg) daily immediately postpartum. The drug was undetectable (<0.1 mcg/L) in a milk sample taken 2 hours after a dose.[2] Infant Levels. Relevant published information was not found as of the revision date.
Effects in breastfed infants
A woman with beta-thalassemia was started on deferasirox 2250 mg (35 mg/kg) daily immediately postpartum and exclusively breastfed her infant. Blood samples were taken from the infant at 1, 10 and 30 days postpartum. Serum ferritin levels were 190, 218, and 96 mcg/L, respectively (normal range 22 to 275 mcg/L). Serum iron levels were 101, 77 and 71 mcg/dL, respectively (normal range 60 to 170 mcg/dL). The infant's growth was normal during the first month at the 41st percentile.[2]
Effects on lactation and breastmilk
Relevant published information was not found as of the revision date.
Alternative drugs to consider
Deferoxamine
References
- Ho PJ, Tay L, Lindeman R, et al. Australian guidelines for the assessment of iron overload and iron chelation in transfusion-dependent thalassaemia major, sickle cell disease and other congenital anaemias. Intern Med J 2011;41:516-24.21615659 PubMed
- Giampreti A, Mattioli F, Faraoni L, et al. Lactation in beta-thalassemia major: Is deferasirox compatible? The first case with clinical data and breastmilk concentrations. Clin Toxicol 2018;56:539. doi:10.1080/15563650.2018.1457818 PubMed
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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