Can you use Dupixent while breastfeeding?

In this article:

• Can you take Dupixent while breastfeeding?
• What are the risks of using Dupixent while breastfeeding?
• What can I take instead of Dupixent while breastfeeding?

In this article

• Can you take Dupixent while breastfeeding?
• What are the risks of using Dupixent while breastfeeding?
• What can I take instead of Dupixent while breastfeeding?

Dupixent (dupilumab) is a subcutaneous injectable medication (injected into the fat layer under the skin) that belongs to a class of medications called monoclonal antibodies, which work by decreasing inflammation in the body. It’s approved by the Food and Drug Administration (FDA) to treat various conditions, including moderate-to-severe atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, prurigo nodularis, and chronic obstructive pulmonary disease (COPD). Off-label uses of Dupixent (uses not approved by the FDA) include contact dermatitis, hand dermatitis, hives, and alopecia areata.

If you are an expectant or new parent, you might want to know about the safety of Dupixent and breastfeeding to determine whether to continue or suspend treatment. Unfortunately, we currently lack adequate safety information about Dupixent and breastfeeding, including how it impacts breastfed babies or breast milk supply. For this reason, healthcare providers tend only to recommend it if they believe the benefits of Dupixent outweigh any potential adverse effects.

Can you take Dupixent while breastfeeding?

It is difficult to determine whether Dupixent is safe while breastfeeding because there simply isn’t enough data from human studies, according to Kecia Gaither, MD, a healthcare provider who is double board-certified in obstetrics and gynecology and maternal-fetal medicine. This includes studies to determine not only whether it is excreted in breast milk but also whether it causes birth defects or perinatal morbidity during pregnancy and delivery.

Because of this, Dr. Gaither says that many healthcare professionals seek alternative treatments before recommending Dupixent. “It is unlikely that many physicians would recommend its use during breastfeeding as the safety of its use hasn’t been proven,” Dr. Gaither says. “Each clinical presentation is different; there is no one set-in-stone answer.”

Andrew Youssouf, MD, who is double board-certified in addiction medicine and emergency medicine and is the medical director of Ikon Recovery, says that although data is lacking, Dupixent is likely safe for many breastfeeding mothers. “This drug is a large protein, so only minimal amounts are expected to pass into breast milk, and what little does pass is likely broken down in your baby’s digestive system,” he says. “Studies and case reports involving breastfeeding mothers on Dupixent have shown no adverse effects in their infants, so this makes it a reasonable option for managing conditions like atopic dermatitis during lactation.”

The problem with the studies that are available when it comes to Dupixent and breastfeeding is that they are studies on a small number of women and babies. Many are case studies where only one mother-baby pair has been studied. For instance, a report published in 2021 noted a previous case of a mother who had been using Dupixent since 20 weeks of pregnancy. Her baby was born without complications, and she continued using Dupixent while breastfeeding. Observations of the baby up to four months of age showed no negative side effects.

Again, though, this is a case study and isn’t enough evidence for healthcare professionals to make recommendations for usage. Dupixent use during breastfeeding is often prescribed on a case-by-case basis, with the healthcare provider weighing benefits versus risks. If the mother uses Dupixent while breastfeeding, both the mother and baby will be carefully monitored for side effects.

RELATED: Dupixent side effects

What are the risks of using Dupixent while breastfeeding?

The research we have so far on the safety of Dupixent while breastfeeding is promising, but it’s not enough to know for sure if it’s safe for breastfed babies.

As Dr. Youssouf notes, the limited evidence we have suggests that Dupixent may be safe for your baby. “No major issues have been reported in infants exposed to the drug through breast milk, according to the studies and case reports available,” he explains.

You may also want to know how using Dupixent might impact your breast milk supply. Again, data is limited, but from what we know so far, risks seem to be low. “Dupixent does not appear to affect breast milk supply,” Dr. Youssouf says. “There is no data indicating that it impacts lactation, so you can continue breastfeeding while on this medication without worrying about it reducing your milk production​.”

So how can you decide whether or not to use Dupixent while breastfeeding? The Academy of American Pediatrics (AAP) recommends that you meet with a healthcare professional who can help you weigh the risks versus benefits when deciding whether to take medication or not while breastfeeding.

The AAP recommends considering the following factors when making this decision:

• How necessary the medication is for the breastfeeding parent
• The amount of medication that is excreted into the breast milk
• How much of the medication is likely absorbed by the baby
• How old the baby is and how frequently the baby is breastfeeding
• Any possible adverse effects on the baby
• Any possible adverse effects on breast milk supply

What can I take instead of Dupixent while breastfeeding?

It’s possible your healthcare provider will clear you to use Dupixent. But if they don’t, or if you don’t feel comfortable using Dupixent, there are alternative medications you might want to consider. Some of these have more research behind them when it comes to breastfeeding safety.

Topical corticosteroids

Topical corticosteroids, like hydrocortisone cream, are a first-line treatment for atopic dermatitis. Although topical hydrocortisone hasn’t been extensively studied during breastfeeding, it’s not likely that short-term application would pass into breast milk or pose harm to breastfeeding babies, according to LactMed at the National Library of Medicine. Experts recommend only using a small amount of a topical steroid on the smallest area of skin as possible. Do not apply this medication to areas where your baby will come into contact while breastfeeding. You should apply it to your nipples directly after nursing, and you should clean off your nipples before nursing again. 

Oral corticosteroids

Oral corticosteroids like prednisone are used to treat many of the same conditions that Dupixent treats, including inflammation, asthma, dermatitis, and eczema. According to LactMed, no adverse effects have been shown among breastfed babies whose mothers took a corticosteroid during breastfeeding. Prednisone in particular is excreted at very low levels into breast milk. However, medium to high amounts of prednisone may cause a temporary drop in milk supply.

Antihistamines

Oral antihistamines are sometimes used to manage symptoms like itching and hives that occur with atopic dermatitis. One breastfeeding-friendly antihistamine to consider is loratadine, sold under the brand name Claritin. LactMed states that, although loratadine is excreted into breast milk in small amounts, the amounts are so low that it doesn’t cause adverse effects in babies. Loratadine is considered a preferred antihistamine to use during breastfeeding because it’s unlikely to cause symptoms like drowsiness in moms or babies.

Of course, these are only some possible alternatives to Dupixent. Your healthcare provider may recommend other options depending on what you’re using Dupixent to treat and any other medications or supplements you may be taking. “With prescriptions, over-the-counter medicines, and supplements, always consult with your healthcare provider before you take anything, especially while pregnant or nursing,” Dr. Youssouf emphasizes.