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The Safety of Breastfeeding While Using Enbrel
from Holly H.

I've been a watcher of your site for a while now.  I've written about cocoa butter and now I have a question.  Why is it that the people who produce Psoriasis products (I'm thinking about Enbrel right this moment) always say that they don't know if the product is excreted in breast milk?  How hard would it be to have a breast feeding mom put their baby on formula, pump their breast milk, and then have it tested for the products?  I mean, some moms (myself included) would be willing to continue to pump for as long as it took to find out if extended use of a product made a difference.

The reason I'm asking is because I'm a breastfeeding mom who had a horrible flare-up about four days postpartum.  I've been suffering up to this point (I'm now three weeks postpartum), and the dermatologist I went to in despair has prescribed Enbrel.  I'm doing my first shot tonight.  (I'm scared stiff — I hate needles.)  I'll keep track of my progress and let you know how it goes.

I would be more than willing to pump breast milk for the next 4-5 months if it would mean that progress could be made to find out if the Enbrel is being excreted in the milk.

Any idea who I'd talk to about this?  Let me know your thoughts. -Holly H.

*****

Ed’s Response:  See  Resident Astronomer’s Pregnancy & Enbrel Dilemma and Enbrel Does the Trick After Post-Partum Flare-up 

What you have run into, Holly, is a little ugly consequence of our litigious society.  I’m talking about the understandable fear pharmaceutical companies have of being sued.  It’s one thing if you or I take a drug and die; for all practical purposes we could not avoid the label warnings and insert warnings and, if we did, we’re partly at fault.  (The dark grey areas, of course — Vioxx, Bextra ... — happen when the adverse event — e.g., heart attack, death... —  is not predicted or cautioned against in the labeling or product insert, or at least not even mentioned as an unknown possibility.)  But if something bad happens to a baby, things are different, more dangerous, more unpredictable, eminently litigious.  It would not take a large aggregate of mothers of wounded or dead babies, all who happened to be nursing while taking the same biologic, to become a major and expensive headache for the biologic’s manufacturer.  And, regarding costs,  it wouldn’t matter if the biologic was to blame or not.  By the time innocence or guilt could be proved, millions could have been spent in the process. 

I imagine a biologic’s manufacturer — Amgen in the case of Enbrel — likes to hear someone else say something like Christy D. did (first link in Ed’s Response, above):

“For those interested in nursing, the Enbrel molecule is too big to transfer into breast milk and would be destroyed by the baby's digestive system even if it did.”

They would like it not because is proves Enbrel is safe to use by nursing mothers, but because it’s not them saying it.  It will probably be a very long time before any manufacturer of a biologic will embrace such a claim as its own.  -Ed

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