coumadin and breast feeding question

[katydid1971]

A few months ago I posted a question about having to take Lovenox during pregnancy and got a lot of helpful advice thank you. Now the time has come and I am 1 week away from delivery!!! YEAH!!! I was put on heprin last week and will go on coumadin after the baby is born. I looked it up and it warns against breast feeding mothers being on coumadin and I was wondering what experience people here have had. Please don't move this to the feeding board because its a question about the drug, not breast feeding. Thanks for your experience and advice, I really appreciate it.
FYI it is also call warfarin and jantoven
Thanks so much!!!!

[Glizmo]

I've also been on lovenox since 15 weeks when I had a DVT, will be switching to heparin in another 3 weeks or so. I've had one doctor tell me to go back on lovenox after delivery (for at least 6 weeks and then re-evaluate) and another tell me coumadin would be safer for breastfeeding. So no advice, but I'm in the same boat and really interested in other replies!

[JenaW]

My favorite resource (as an OBGYN physician assistant) is "Medications and Mothers' Milk" by Thomas Hale. I prefer his answers over other "experts" because he understands how the drug gets into breast milk and how it is excreted. In his book, it states the APP considers it "usually compatible with breastfeeding." It is an L2 classification meaning that limited studies have been done, but no adverse effects in infants were noted. Coumadin is a highly protein bound drug and therefore "very small and insignificant amounts are secreted into breast milk, but it depends to some degree on the dose administrated." The book does not state what dosages are considered safe or unsafe. I know pharmacists generally discourage against using coumadin, although I have never heard one give an adequate explanation why. I do recall reading somewhere that there have been instances of bleeding issues in breastfed babies whose mothers were taking high doses of coumadin, but again, I do not know what would constitute a "high dose" and whether or not it depends what your INR is on that dose. Dr. hale does mention watching the infant for bleeding issues (bleeding, bruising, etc) and states that vitamin K (which is a known 'antidote' for coumadin) can be given to the infant if necessary.

I continue my heparin injections 6 weeks postpartum and have never had a problem with my newborns (who are exclusively breastfed), including when I was pumping for my 25 week preemie.

Hope I didn't confuse you more.

Jera

[MaiseyDog]

Yeah!!! I can answer this. So often I'm in awe at the knowledge possessed on this board and rarely get to share, but this I know. I'm a clinical pharmacist and practice in an anticoagulation clinic. We consider Coumadin to be compatable with breastfeeding, but do tell all our nursing mothers to let their pediatrician know they are taking Coumadin. The risk is low and rare, but it is possible for some Coumadin to pass to the child leading to unusual bleeding. As I said it is very rare for it to cause problems, but it is best to let the pediatrican know. I do have one pediatrician that insists on checking a PT/INR on the infant periodically if the mother is nursing, but I really don't feel it is necessary. Anyway, hope this helps and best of luck.

[katydid1971]

Thanks so much for the information. I really didn't want to go back on Lovenox but I want what's best for my baby, that's why on this stuff to begin with. I always appreciate the good information that I get here. Thank you my BBB budies!!!!