Breastfeeding in the Multiple Sclerosis Patient

Older drugs for MS, such as glatiramer, interferon beta, IVIG and methylprednisolone, appear to be acceptable to use during breastfeeding. The newer monoclonal antibodies, natalizumab and rituximab appear promising in breastfeeding, but safety information is limited. All of these drugs are given by injection. The more convenient oral drugs, fingolimod, siponimod, dimethyl fumarate and teriflunomide have no information on use during breastfeeding. Two chemotherapy drugs, cladribine and mitoxantrone, might be able to be used with a period of breastfeeding abstinence following their intermittent use. Among adjunctive drugs for spasticity, only baclofen has some safety information and can be used with infant monitoring for sedation. A general strategy for new mothers with MS is to encourage exclusive breastfeeding postpartum, because it might lessen relapse. Monthly IVIG or methylprednisolone injections might be adequate for many women to avoid a DMT for a few months. If needed, glatiramer and interferon beta can be introduced with little apparent concern for the infant's safety. If symptoms return, second-line drugs with less clear safety profiles might have to be used, and breastfeeding might have to be disrupted or discontinued. © Copyright 2019, Mary Ann Liebert, Inc., publishers 2019.