[Breastfeeding and drug management in connective tissue and rheumatic diseases]

Breastfeeding is often contraindicated when drugs are prescribed for a chronic maternal disease. Many of the restrictions are based on theoretical concerns only and may be excessively cautious. An updated review is mandatory. Many antirheumatic drugs can be safely used during lactation: nonsteroidal anti-inflammatory drugs, corticosteroids, sulfasalazine, antimalarial agents. Doubt remains about safety of cochicine or dapsone. Expert opinions still diverge but move on in favor the use of azathioprine, ciclosporin, and even methotrexate. Leflunomide, mycophenolate mofetil and cyclophosphamide are contraindicated. No conclusion can be reached regarding anti-TNF-alpha and rituximab. Current knowledge about drug transfer in breast-milk and cumulative empirical data have expanded the possibilities to allow breastfeeding when the mother is treated with antirheumatic medications. The data provided by pharmaceutical industry should not be the only source of the physician's information in the risk assessment.