Lepirudin and Breastfeeding

Summary of use during lactation

Lepirudin is no longer marketed in the United States. Limited information indicates that lepirudin in doses up to 100 mg daily produce very low levels in milk. Because of its large molecular weight, it would not be expected to be absorbed from breastmilk by the infant. Lepirudin would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.[1]

Drug levels in milk and infant serum

Maternal Levels. One mother who was 10 weeks postpartum received lepirudin 50 mg twice daily subcutaneously. Her breastmilk had undetectable (<0.1 mg/L) lepirudin levels 3 hours after a dose.[2] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

One infant was breastfed for 3 months during therapeutic lepirudin use beginning at 7 weeks of age. No bleeding events occurred.[2]

Effects on lactation and breastmilk

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

Alternative drugs to consider

Acenocoumarol, Dalteparin, Enoxaparin, Heparin, Rivaroxaban, Warfarin

References

1. BatesSM RajasekharA MiddeldorpS American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Adv 2018 2 3317 59 30482767 PubMed
2. Lindhoff-LastE WillekeA ThalhammerC Hirudin treatment in a breastfeeding woman. Lancet 2000 355 467 8 10841132 PubMed