clopidogrel and breastfeeding

Last edited 07/2023 and last reviewed 07/2023

Clopidogrel and Breastfeeding

• NHS Specialist Pharmacy Service state (1):
  • use with caution
    • is no information on the amount of clopidogrel which passes into breast milk although levels are likely to be low.  It can be used with caution during breastfeeding but monitoring is required
  • monitoring
    • monitor the infant for diarrhoea, constipation or skin reactions, and for signs of bruising or bleeding which could be prolonged

Notes

• is no published evidence of use of clopidogrel during breastfeeding (1)
• LactMed states (2):
  • since no published information is available on the use of clopidogrel during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding
• clopidogrel's pharmacokinetic properties, including high protein binding and short half life are likely to limit the amount in breast milk, and its reduced oral bioavailability will limit absorption by the infant (1)
  • note though that clopidogrel has a metabolite that irreversibly binds to platelets so any that is absorbed by the infant could have a prolonged effect.
• manufacturers state that no side effects have been reported in breastfed infants in a small number of post marketing cases (1)

Reference:

• NHS Specialist Pharmacy Service (July 2023). Using antiplatelet medicines during breastfeeding
• Drugs and Lactation Database (LactMed [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Clopidogrel. [Updated 2019 Jun 3]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535609/