Related Experiment Video
Updated: Jul 2, 2026
04:50
Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
Published on: May 16, 2025
Azathioprine treatment during lactation
L A Christensen1, J F Dahlerup, M J Nielsen
1Department of Medicine V, Arhus University Hospital, Arhus, Denmark. lachr@as.aaa.dk
Alimentary Pharmacology & Therapeutics
|September 3, 2008
Summary
Breastfeeding during azathioprine therapy is safe. Infants ingest minimal 6-mercaptopurine (a metabolite of azathioprine) via breast milk, with most excreted within 4 hours, supporting continued breastfeeding for inflammatory bowel disease management.
Area of Science:
- Pharmacology
- Gastroenterology
- Pediatrics
Background:
- Thiopurines, like azathioprine, are crucial for maintaining remission in inflammatory bowel disease (IBD).
- While IBD treatment during pregnancy is recommended, guidelines for breastfeeding are inconsistent.
- This study addresses infant exposure to 6-mercaptopurine (6-MP), a key metabolite of azathioprine, through maternal breast milk.
Purpose of the Study:
- To quantify the exposure of breastfed infants to 6-mercaptopurine (6-MP) from maternal milk.
- To assess the safety of breastfeeding for infants whose mothers are undergoing azathioprine therapy for IBD.
Main Methods:
- Studied eight lactating women with IBD on azathioprine (75-200 mg/day).
- Collected maternal milk and plasma samples at 30, 60 minutes, and hourly for 5 hours post-drug administration.
- Analyzed 6-MP concentrations in both plasma and milk samples.
Main Results:
- Peak plasma 6-MP concentrations varied widely within the first 3 hours.
- Maternal milk showed a delayed 6-MP concentration curve (1-hour delay) with significantly lower levels (2-50 microg/L).
- After 6 hours, milk 6-MP levels averaged 10% of peak plasma values.
Conclusions:
- The majority of 6-MP in breast milk is excreted within 4 hours of maternal drug intake.
- Estimated infant 6-MP ingestion is less than 0.008 mg/kg/24h, based on peak concentrations.
- Breastfeeding during azathioprine treatment is deemed safe and should be encouraged for IBD patients due to its benefits.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:29Drugs for Treatment of Ulcerative Colitis in IBD
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide generation.
01:20Myasthenia Gravis: Overview and Treatment
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which leads...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which leads...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...