Emicizumab and Breastfeeding

Summary of use during lactation

A low level of emicizumab was found in the milk of one woman. The drug is likely to be partially destroyed in the infant's gastrointestinal tract and absorption by the infant is probably minimal.[1] Waiting for at least 2 weeks postpartum to resume therapy may minimize transfer to the infant.[2]

Drug levels in milk and infant serum

Maternal Levels. A woman with severe hemophilia A received emicizumab every 4 weeks (dose not stated, but probably 6 mg/kg) throughout pregnancy and postpartum as well as recombinant factor VIIa (NovoSeven) 90 mcg/kg every 2 hours initially with a gradually increasing dosage interval postpartum for severe bleeding. A milk sample taken at an unreported time contained 38 mg/L of emicizumab.[3] Infant Levels. A woman with severe hemophilia A was receiving emicizumab every 4 weeks (dose not stated, but probably 6 mg/kg) throughout pregnancy and postpartum as well as recombinant factor VIIa (NovoSeven) 90 mcg/kg every 2 hours initially with a gradually increasing dosage interval postpartum for severe bleeding. A serum sample taken from the infant at an unreported time contained 106 mg/L of emicizumab, probably obtained transplacentally.[3]

Effects in breastfed infants

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

Effects on lactation and breastmilk

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

References

1. Anderson PO. Monoclonal antibodies during breastfeeding. Breastfeed Med 2021;16:591-3.33956488 PubMed
2. Krysko KM, Dobson R, Alroughani R, et al. Family planning considerations in people with multiple sclerosis. Lancet Neurol 2023;22:350-66.36931808 PubMed
3. Kharel Z, Pruthi RK, Kouides PA, Reid R. Transplacental transfer of emicizumab: Experience with emicizumab in a pregnant female with severe hemophilia A and an inhibitor. Blood 2023;142:5492. doi:10.1182/blood-2023-190012