Safety of Drugs in Breastfeeding Women With CKD
Introduction: The benefits of breastfeeding are widely recognized. Because of lack of evidence, women may forego breastfeeding or decline treatments that impact long-term renal survival. Therefore, we systematically reviewed the evidence on the breastfeeding safety of drugs commonly prescribed to wo...
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Elsevier
2025-07-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024925002633 |
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| author | Paula Parnizari Michelle A. Hladunewich Jonathan Zipursky |
| author_facet | Paula Parnizari Michelle A. Hladunewich Jonathan Zipursky |
| author_sort | Paula Parnizari |
| collection | DOAJ |
| description | Introduction: The benefits of breastfeeding are widely recognized. Because of lack of evidence, women may forego breastfeeding or decline treatments that impact long-term renal survival. Therefore, we systematically reviewed the evidence on the breastfeeding safety of drugs commonly prescribed to women with chronic kidney disease (CKD). Methods: We conducted bibliographic search on available databases, including PUBMED, REPROTOX, and LACTMED. Results: We reviewed a total of 81 observational studies and case reports. Among renin-angiotensin system inhibitors, enalapril and captopril are safe for breastfeeding. Based on limited evidence, quinapril, benazepril, candesartan, and valsartan are likely acceptable for use during breastfeeding. We found no compelling human data regarding the safety of other renin-angiotensin system inhibitors or sodium-glucose cotransporter type 2 (SGLT2) inhibitors, finerenone, sparsentan, or glucagon-like peptide-1 receptor agonists (GLP1RAs) in lactation. Immunosuppressive agents, including azathioprine, cyclosporine, tacrolimus, budesonide, rituximab, and eculizumab are acceptable for use during breastfeeding. Belimumab is most likely safe; however, data are limited. Data on mycophenolate use are conflicting, and the general recommendation is avoidance during lactation. No studies were found on the safety of breastfeeding while on the newer complement inhibitors, including avacopan, ravulizumab, iptacopan, and pegcetacoplan. These drugs should used with caution in breastfeeding until data become available. Conclusion: Human lactation data on the safety of most drugs used in the treatment of CKD are limited, making evidence-based recommendations challenging. Emerging pharmacometrics techniques can contribute to the safety assessment of drugs in breastfeeding, overcoming ethical and practical issues associated with clinical trials in this population. |
| format | Article |
| id | doaj-art-393c3652e9fc450ea05da4b9813779db |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-393c3652e9fc450ea05da4b9813779db2025-08-20T03:26:48ZengElsevierKidney International Reports2468-02492025-07-011072189220110.1016/j.ekir.2025.04.038Safety of Drugs in Breastfeeding Women With CKDPaula Parnizari0Michelle A. Hladunewich1Jonathan Zipursky2Centro de Nefrología, Hospital de Clinicas “Manuel Quintela”, Facultad de Medicina, Universidad de la República, Montevideo, UruguayDivision of Obstetrical Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Correspondence: Michelle A. Hladunewich, Divisions of Nephrology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto, 3rd Floor CNIB, Nanji Family Kidney Center, 1929 Bayview Ave., Toronto, Ontario M4G 3E8, Canada.Division of Obstetrical Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaIntroduction: The benefits of breastfeeding are widely recognized. Because of lack of evidence, women may forego breastfeeding or decline treatments that impact long-term renal survival. Therefore, we systematically reviewed the evidence on the breastfeeding safety of drugs commonly prescribed to women with chronic kidney disease (CKD). Methods: We conducted bibliographic search on available databases, including PUBMED, REPROTOX, and LACTMED. Results: We reviewed a total of 81 observational studies and case reports. Among renin-angiotensin system inhibitors, enalapril and captopril are safe for breastfeeding. Based on limited evidence, quinapril, benazepril, candesartan, and valsartan are likely acceptable for use during breastfeeding. We found no compelling human data regarding the safety of other renin-angiotensin system inhibitors or sodium-glucose cotransporter type 2 (SGLT2) inhibitors, finerenone, sparsentan, or glucagon-like peptide-1 receptor agonists (GLP1RAs) in lactation. Immunosuppressive agents, including azathioprine, cyclosporine, tacrolimus, budesonide, rituximab, and eculizumab are acceptable for use during breastfeeding. Belimumab is most likely safe; however, data are limited. Data on mycophenolate use are conflicting, and the general recommendation is avoidance during lactation. No studies were found on the safety of breastfeeding while on the newer complement inhibitors, including avacopan, ravulizumab, iptacopan, and pegcetacoplan. These drugs should used with caution in breastfeeding until data become available. Conclusion: Human lactation data on the safety of most drugs used in the treatment of CKD are limited, making evidence-based recommendations challenging. Emerging pharmacometrics techniques can contribute to the safety assessment of drugs in breastfeeding, overcoming ethical and practical issues associated with clinical trials in this population.http://www.sciencedirect.com/science/article/pii/S2468024925002633breast milkbreastfeedingchronic kidney diseasedrugs |
| spellingShingle | Paula Parnizari Michelle A. Hladunewich Jonathan Zipursky Safety of Drugs in Breastfeeding Women With CKD Kidney International Reports breast milk breastfeeding chronic kidney disease drugs |
| title | Safety of Drugs in Breastfeeding Women With CKD |
| title_full | Safety of Drugs in Breastfeeding Women With CKD |
| title_fullStr | Safety of Drugs in Breastfeeding Women With CKD |
| title_full_unstemmed | Safety of Drugs in Breastfeeding Women With CKD |
| title_short | Safety of Drugs in Breastfeeding Women With CKD |
| title_sort | safety of drugs in breastfeeding women with ckd |
| topic | breast milk breastfeeding chronic kidney disease drugs |
| url | http://www.sciencedirect.com/science/article/pii/S2468024925002633 |
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