Breastfeeding Drug Compatibility — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeBreastfeeding Drug CompatibilitySCE Rheumatology

A 28-year-old woman with SLE on Hydroxychloroquine and Azathioprine has just delivered a healthy baby. She plans to breastfeed. Which of her medications are compatible with breastfeeding?

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Correct answer: C — Both Hydroxychloroquine and Azathioprine are compatible with breastfeeding according to BSR and specialist lactation guidance

BSR 2016 prescribing in pregnancy guidelines and EULAR 2024 recommendations confirm that both Hydroxychloroquine and Azathioprine are compatible with breastfeeding. The amount of HCQ excreted in breast milk is very small and poses negligible risk to the infant. Azathioprine and its metabolite 6-mercaptopurine are present in breast milk at very low concentrations (typically <1% of maternal dose) and are considered safe. Other breastfeeding-compatible medications include Prednisolone (≤40 mg avoid feeding for 4 hours after high doses) NSAIDs (short-acting preferred e.g. Ibuprofen) and Sulfasalazine. Methotrexate Mycophenolate Cyclophosphamide and Leflunomide are NOT compatible with breastfeeding.

Reference: BSR 2016 prescribing in pregnancy; EULAR 2024 antirheumatic drugs in reproduction