COVID-19 Vaccines & Medications
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Medications COVID-19 Vaccines & Medications

COVID-19 Vaccines & Medications

COVID-19 medication options are rapidly changing and becoming available. Data is limited on using these medications in lactating individuals and their infants. The following information is based on currently available information on vaccines and treatment options for COVID-19.

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

COVID-19 Vaccinations

Two recent systematic reviews of multiple studies found no serious adverse events have been reported in lactating women or their infants. The available evidence suggested there may be an increase, decrease, or no change in milk production with less than 10% of those studied experiencing decreased milk production. Decreases in milk production were reported to resolve within 3 days (1, 2, 3). There is no absolute indication to pump and dump after receiving COVID-19 vaccinations.

Antibodies

These medications are generally considered safe in lactation due to their high molecular weights, low levels in breastmilk, and poor oral bioavailability with partial destruction of these molecules in the baby’s gastrointestinal tract (1).

  • Monoclonal antibodies (bebtelovimab, sotrovimab, tocilizumab): Monoclonal antibodies have high molecular weights and have very low levels in breastmilk. They have poor oral bioavailability and are partly destroyed by the baby’s gastrointestinal tract (1). There is no absolute indication to pump and dump.
  • Polyclonal antibodies (convalescent plasma): The antibodies are obtained from the blood of someone who had COVID-19 previously (1). There is no absolute indication to pump and dump.

Antivirals

These medications are generally not an absolute indication to pump and dump except molnupavir.

  • Remdesivir: This drug has poor oral bioavailability and is given intravenously to patients with severe COVID-19. Even if the infant ingests this medication, it is unlikely to have significant systemic absorption or effects due to poor oral bioavailability (although studies on oral bioavailability of the active metabolite are unavailable). Infants who received this medication intravenously for Ebola treatment did not have significant adverse effects (1). While there is limited data on this medication in lactation, it has poor oral bioavailability so there is no absolute indication to pump and dump.
  • Paxlovid (nirmatrelvir/ritonavir): Nirmatrelvir is a nucleoside analog with better efficacy against COVID-19 than molnupiravir. Nirmatrelvir has poor oral bioavailability. Ritonavir has been studied in breastfeeding mothers being treated for HIV infection and is excreted into milk in low concentrations. Low levels of ritonavir have been found in the blood of some breastfed infants though no adverse reactions have been reported. This combination is unlikely to adversely affect the breastfeeding dyad (1). Although there is no absolute indication to pump and dump, shared decision-making is recommended regarding this medication prior to initiating it due to there being limited data on it in lactation.
  • Molnupavir: Efficacy is only moderate at preventing severe disease and we do not have data on the use of this medication lactating parents (). Out of an abundance of caution, lactating parents should pump and dump during treatment and for at least 24 hours after their last dose.

References

  1. Anderson PO. COVID-19 Drugs and Breastfeeding Update. Breastfeed Med. 2022; 17: 1-3. DOI: https://doi.org/10.1089/bfm.2022.0066.
  2. De Rose DU, Salvatori G, Dotta A, Auriti C. SARS-CoV-2 Vaccines during Pregnancy and Breastfeeding: A Systematic Review of Maternal and Neonatal Outcomes. Viruses vol. 14,3 539. 5 Mar. 2022. DOI: https://doi.org/10.3390%2Fv14030539.
  3. Muyldermans J, De Weerdt L, De Brabandere L, et al. The Effects of COVID-19 Vaccination on Lactating Women: A Systematic Review of the Literature. Front Immunol. 2022;13:852928. Published 2022 Apr 8. DOI: https://doi.org/10.3389%2Ffimmu.2022.852928