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AI-Generated response:

Is it safe to breastfeed while taking tuberculosis medicines?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Yes, it is generally safe to breastfeed while taking tuberculosis medicines such as isoniazid, pyrazinamide, and rifampin, as the concentrations of these drugs in breast milk are low and not reported to produce toxic effects in the nursing infant.

However, monitor infants for any adverse effects and consider pyridoxine supplementation for both mother and infant.

  • Isoniazid, pyrazinamide, and rifampin are excreted into breast milk in small amounts that have not been associated with toxicity in infants.[1-3]

  • The FDA and tuberculosis guidelines support breastfeeding while on these medications, emphasizing the benefits of breastfeeding and the low risk posed by the medication levels in breast milk.[3-4]

  • Pyridoxine supplementation is recommended for both the breastfeeding mother and the infant to prevent potential side effects related to isoniazid use.[1][3]

  • It is important to ensure that the mother is noninfectious before encouraging breastfeeding to prevent transmission of tuberculosis.[5]

  • Monitor the nursing infant for any signs of adverse effects, especially when medications like rifapentine are used, as they may cause hepatotoxicity.[6]

Additional info

When treating a breastfeeding mother with tuberculosis, it is crucial to balance the benefits of breastfeeding with the potential risks of drug exposure through breast milk. The primary tuberculosis medications—isoniazid, pyrazinamide, and rifampin—are generally considered safe during breastfeeding due to their low milk/plasma ratio and minimal adverse effects observed in infants. However, continuous monitoring of the infant for any signs of drug toxicity or adverse reactions is essential. Additionally, supplementation with pyridoxine (vitamin B6) is advised to counteract the possible depletion caused by isoniazid and to prevent associated neurological issues in both the mother and the infant.In cases where more potent or less studied drugs are required (e.g., rifapentine), careful monitoring for specific side effects such as hepatotoxicity is necessary. Consulting with a TB expert can provide additional guidance, especially in complex cases or when drug-resistant TB is suspected. The decision to continue breastfeeding should always consider the clinical status of the mother, the effectiveness of the TB treatment, and the overall health of the infant.

References

Reference 1

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: February 4, 2024.

Contraindications And Precautions Isoniazid is excreted into breast milk. Encourage breast-feeding for women who are noninfectious and taking first-line tuberculosis agents, such as isoniazid, as the small concentrations of these drugs measured in breast milk have not been reported to produce toxic effects in the nursing infant. Pyridoxine supplementation is recommended for the mother and breast-feeding infant.

Lactation Isoniazid is excreted into breast milk. Encourage breast-feeding for women who are noninfectious and taking first-line tuberculosis agents, such as isoniazid, as the small concentrations of these drugs measured in breast milk have not been reported to produce toxic effects in the nursing infant. Pyridoxine supplementation is recommended for the mother and breast-feeding infant.

Reference 2

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: February 5, 2024.

Lactation Use pyrazinamide with caution in breast-feeding mothers, taking into account the risk-benefit of this therapy. Pyrazinamide has been found in small amounts in breast milk. Tuberculosis guidelines encourage breast-feeding for women who are noninfectious and being treated with first-line tuberculosis agents, such as pyrazinamide, as the small concentrations of these drugs measured in breast milk have not been reported to produce toxic effects in the nursing infant.

Reference 3

3.

Elsevier ClinicalKey Drug Monograph

Content last updated: May 4, 2024.

Contraindications And Precautions Isoniazid, pyrazinamide, and rifampin are excreted into breast milk. FDA-approved labeling recommends discontinuing breast-feeding or isoniazid; pyrazinamide; rifampin, taking into consideration the importance of the drug to the mother. However, guidelines encourage breast-feeding for women who are noninfectious and taking first-line tuberculosis agents, such as isoniazid, pyrazinamide, and rifampin, as the small concentrations of these drugs measured in breast milk have not been reported to produce toxic effects in the nursing infant. Pyridoxine supplementation is recommended for the mother and breast-feeding infant.

Reference 4

4.

Food and Drug Administration (DailyMed).

Publish date: October 2, 2022.

Precautions Isoniazid has been found to be weakly mutagenic in strains TA 100 and TA 1535 of Salmonella typhimurium (Ames assay) without metabolic activation. Pregnancy Teratogenic Effects Pregnancy Category C Isoniazid has been shown to have an embryocidal effect in rats and rabbits when given orally during pregnancy. Isoniazid was not teratogenic in reproduction studies in mice, rats, and rabbits. There are no adequate and well-controlled studies in pregnant women. Isoniazid should be used as a treatment for active tuberculosis during pregnancy because the benefit justifies the potential risk to the fetus. The benefit of preventive therapy also should be weighed against a possible risk to the fetus. Preventive therapy generally should be started after delivery to prevent putting the fetus at risk of exposure; the low levels of isoniazid in breast milk do not threaten the neonate. Since isoniazid is known to cross the placental barrier, neonates of isoniazid-treated mothers should be carefully observed for any evidence of adverse effects. Nonteratogenic Effects Since isoniazid is known to cross the placental barrier, neonates of isoniazid-treated mothers should be carefully observed for any evidence of adverse effects. Nursing Mothers The small concentrations of isoniazid in breast milk do not produce toxicity in the nursing newborn; therefore, breast feeding should not be discouraged. However, because levels of isoniazid are so low in breast milk, they can not be relied upon for prophylaxis or therapy of nursing infants.

Reference 5

5.

Cameron, Lindsay H., Starke, Jeffrey R. (2025). Tuberculosis (Mycobacterium tuberculosis). In Nelson Textbook of Pediatrics (pp. 1835). DOI: 10.1016/B978-0-323-88305-4.00261-3

Once the mother and child are taking adequate therapy, it is usually safe for the mother to breastfeed, because the medications, although found in milk, are present in low concentrations. If isoniazid resistance is suspected or the mother’s adherence to medication is in question, continued separation of the infant from the mother should be considered. The duration of separation must be at least as long as is necessary to render the mother noninfectious. A TB expert should be consulted if the young infant has potential exposure to the mother or another adult with TB disease caused by an isoniazid-resistant strain ofM. tuberculosis. Although isoniazid is not thought to be teratogenic, the treatment of pregnant women who have asymptomatic TBI is often deferred until after delivery. However, symptomatic pregnant women or those with radiographic evidence of TB disease should be appropriately evaluated. Because pulmonary TB is harmful to both the mother and the fetus and represents a great danger to the infant after delivery, TB in pregnant women always should be treated. The most common regimen for drug-susceptible TB is isoniazid, rifampin, and ethambutol. The aminoglycosides and ethionamide should be avoided because of their teratogenic effect. The safety of pyrazinamide in pregnancy has not been established. Visit Elsevier eBooks+ ateBooks.Health.Elsevier.comfor Bibliography.

Reference 6

6.

Food and Drug Administration (DailyMed).

Publish date: July 5, 2018.

Information For Patients Contact lenses or dentures may be permanently stained [see Warnings and Precautions (5.6) ]. Administration with Food Advise patients to take Priftin (rifapentine) with food. Lactation Monitor infants exposed to Priftin (rifapentine) through breast milk for signs of hepatotoxicity to include irritability, prolonged unexplained crying, yellowing of the eyes, loss of appetite, vomiting, and changes in color of the urine (darkening) or stool (lightening, pale or light brown) [see Use in Specific Populations (8.2) ]. Contraception Advise patients that use of Priftin (rifapentine) may reduce the efficacy of hormonal contraceptives. Advise patients using hormonal contraceptives to use an alternative non-hormonal contraceptive method or add a barrier method of contraception during treatment [see Warning and Precautions (5.5), Drug Interactions (7.3), and Use in Specific Populations (8.3) ].

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