Medicines for breastfeeding women with rheumatic disease

Women with rheumatic disease often need medicinal treatment in the period of time while they are breastfeeding. Many women are unsure what is safe and get conflicting advice about safe medicines while breastfeeding. This may cause some women to stop breastfeeding needlessly, or make them reluctant to take the medicines they need.

Talk to your healthcare provider

For some medicines, there are clear recommendations on whether it is safe to breastfeed or not. However, in some cases, individual assessments must be made, where the specialist weighs up the benefits and risks. It is important that you and your rheumatologist discuss and make a plan for this during your pregnancy.

Based on international systematic reviews of medical research, we know that a number of anti-rheumatic drugs are safe for pregnant and breastfeeding women to take. These systematic reviews often provide information that conflicts with what is stated on the package leaflet that comes with the medicine. 

The many benefits of breast milk are well known, which means that there should be sound clinical grounds for discouraging mothers from breastfeeding.

General overview of recommendations

Below is an overview of recommendations regarding breastfeeding for medicines typically taken by women with rheumatic disease. Please note that this is general advice only, and you must always discuss your own personal medication with your rheumatologist. The timing of when you should start taking your medicines after childbirth must also always be clarified with your specialist. 

  • IL inhibitors (anakinra, canakinumab, tocilizumab, ixekizumab, secukinumab, utekinumab, guselkumab, risankizumab): limited clinical data. Discuss with your rheumatologist.
  • Imurel®: can be taken while breastfeeding depending on the dose. Discuss with your rheumatologist.
  • JAK inhibitors: should not be taken while breastfeeding. 
  • Methotrexate: should not be taken while breastfeeding.
  • Orencia®: limited clinical data. Discuss with your rheumatologist.
  • Plaquenil®: can be taken while breastfeeding. 
  • Prednisolone®: doses of ≤20 mg/day can be taken while breastfeeding. At higher doses, it may be advisable to delay breastfeeding; discuss with your rheumatologist.
  • Salazopyrin®: can be taken while breastfeeding, but not if the baby was born prematurely or has jaundice. Discuss with your rheumatologist.

TNF inhibitors (adalimumab, etanercept, certolizumab, golimumab, infliximab): can be taken while breastfeeding.

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

Monday-Friday from 08:00 to 15:00

Advises both patients and health professionals.

Norsk revmatikerforbund (Norwegian Rheumatism Association)

22 54 76 00

Tuesday from 10:00 to 15:00

Wednesday from 10:00 to 15:00

Thursday from 10:00 to 15:00

Calls are answered by people with a rheumatic disease, who can give you advice and guidance.

Podcast: Revmamas

A podcast (in Norwegian) for women who have a rheumatic disease and are planning a pregnancy or are pregnant. 

You’ll find it where you usually listen to podcasts, like Spotify for example.

Trygg mammamedisin

Get advice from professionals about safe medication use during pregnancy and breastfeeding. The service is free of charge.

Content provided by The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR). Medicines for breastfeeding women with rheumatic disease. [Internet]. Oslo: The Norwegian Directorate of Health; updated Tuesday, October 10, 2023 [retrieved Friday, June 14, 2024]. Available from: https://www.helsenorge.no/en/pregnancy-and-maternity-care-in-norway/pregnancy-childbirth-family-life-rheumatic-disease/medicines-for-breastfeeding-women-with-rheumatic-disease/

Last updated Tuesday, October 10, 2023