ticagrelor and breastfeeding

Last edited 07/2023 and last reviewed 07/2023

Ticagrelor and Breastfeeding

• use with caution
  • is no information on the amount  of prasugrel 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 skin reactions, and for signs of bruising or bleeding which could be prolonged

Notes:

• is no published evidence of use of ticagrelor during breastfeeding
• LactMed states (2)
  • because ticagrelor and its active metabolite are more than 99% bound to plasma proteins, the amount in milk is likely to be low
  • if ticagrelor is used by a nursing mother, monitor the infant for bruising and bleeding
  • an alternate drug may be preferred, especially while nursing a newborn or preterm infant
• ticagrelor's high protein binding is likely to limit the amount excreted into milk.  However, prasugrel irreversibly binds to platelets so any that is absorbed could have a prolonged effect
• no side effects have been reported in breastfed infants
• as ticagrelor has a reversible antiplatelet effect, the duration of any potential side effects relating to bleeding would be less than with an irreversible antiplatelet agent (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-. Ticagrelor. [Updated 2019 Jun 3]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK543167/