Teriparatide and Breastfeeding

Summary of use during lactation

One infant with congenital hyperparathyroidism was breastfed during maternal use of teriparatide. The infant appeared to be protected against hypoparathyroidism by breastfeeding. Because of the potential for osteosarcoma in animal studies, the manufacturer of teriparatide advises that breastfeeding is not recommended during treatment with teriparatide. Palopegteriparatide is a prodrug of teriparatide and should have similar concerns during breastfeeding. Neither drug is absolutely contraindicated during breastfeeding. If one of these drugs is used in a nursing mother, monitor breastfed infants for signs and symptoms of hypercalcemia or hypocalcemia. Serum calcium monitoring should also be considered.

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 woman with autosomal dominant hypoparathyroidism type 1 (ADH1) was treated with teriparatide 28 mcg daily by continuous infusion during pregnancy. She also took vitamin D3 1000 IU daily, magnesium oxide 400 mg twice daily, and calcium carbonate 0 to 3 grams orally depending on serum calcium. The infusion was continued for 8 months postpartum in doses ranging from 27 to 30 mcg daily when calcitriol 0.5 mcg twice daily was substituted. She breastfed her infant exclusively for 6 months then with supplementation to 1 year. Her infant had no change in serum calcium when maternal calcitriol was begun. The mother began weaning at 11 months and at 1 year of age when weaning was complete, her infant developed hypocalcemia and was diagnosed with ADH1 and the same genetic mutation as her mother and other family members. Serum parathyroid hormone-related protein levels in the infant were in the mid-normal range during the first year while nursing. A single sample drawn after weaning showed her level had dropped markedly. The breastfed infant appeared to be protected from severe hypocalcemia during the first year of life by the mother’s breastmilk. Growth and development were normal at 1.5 years of age.[1]

Effects on lactation and breastmilk

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

Alternative drugs to consider

Parathyroid Hormone

References

1. Shulman D. Subcutaneous infusion of rhPTH(1-34) during pregnancy and nursing in a woman with autosomal dominant hypoparathyroidism 1. J Endocr Soc 2022;6:bvac031.35350394 PubMed