Bevacizumab

Drug Levels and Effects:




Summary of Use during Lactation:


No information is available on the systemic use of bevacizumab during breastfeeding. Until more data become available, an alternative drug may be preferred, especially while nursing a newborn or preterm infant.

Two infants were breastfed, apparently without noticeable harm, following maternal intravitreal bevacizumab injections. Bevacizumab was undetectable in the milk of one mother, but vascular endothelial growthfactor(VEGF) levels in breastmilk were suppressed following the injection. Because the breast and neonatal intestine have VEGF receptors, some authors recommend use of intravitreal ranibizumab, which does not appear to depress milk VEGF levels.[1]


Drug Levels:


Maternal Levels.

A woman was given 3 intravitreal injections of bevacizumab for scar-associated choroidal neovascularization in her left eye. Her breastfed infant was 12 weeks old at the start of therapy. The bevacizumab dose and interval were not stated in the published report, but the usual intravitreal dose is 1.25 mg. After the first injection, bevacizumab was detectable in the maternal serum with a peak between 0.6 and 0.7 mcg/L at one week, but bevacizumab was not detectable in breastmilk at any time over the 42 days following injection. Vascular endothelial growthfactor(VEGF) was also measured in serum and breastmilk. After the intravitreal injection of bevacizumab, the VEGF level in breastmilk decreased from 13.3 to 8.6 mcg/L over a 2-week period. After changing therapy to ranibizumab, no decrement in breastmilk VEGF was seen.[1]

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


A 33-year-old woman was treated with 14 intravitreal bevacizumab injections of 1.25 mg over a 20-month period. Five of these injections were given while she was breastfeeding (age of infant not stated). No mention was made of adverse effects in this infant, but she became pregnant again, received 3 additional injections, and delivered an infant who developed normally at 12 months of age.[2]

A woman was given 3 intravitreal injections of bevacizumab for scar-associated choroidal neovascularization in her left eye. Her breastfed infant was 12 weeks old at the start of therapy. No mention was made of adverse effects in this infant.[1]


Possible Effects on Lactation:


Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:


(Intravitreal) Ranibizumab


References:


1. Ehlken C, Martin G, Stahl A, Agostini HT. Reduction of vascular endothelial growthfactora in human breast milk after intravitreal injection of bevacizumab but not ranibizumab. Arch Ophthalmol. 2012;130:1226-7. PMID:22965611
2. Tarantola RM, Folk JC, Boldt HC, Mahajan VB. Intravitreal bevacizumab during pregnancy. Retina. 2010;30:1405-11. PMID:20924262



Substance Identification:




Substance Name:

Bevacizumab

CAS Registry Number:

216974-75-3

Drug Class:


  • Angiogenesis Inhibitors

  • Antibodies, Monoclonal, Humanized

  • Antineoplastic Agents


  • Administrative Information:




    LactMed Record Number:


    825


    Last Revision Date:


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