To : Mary Dour-O'Neill
Re : Azathioprine(Imuran)

        Azathioprine is a powerful immunosuppressant drug, that in vivo is
converted to 6-mercaptopurine(6-MP).  Both azathioprine and 6-MP coexist in
the plasma, and are poorly protein bound (only 30%), which could lead to
higher milk levels.  Azathioprine is well absorbed orally.  Although I have
seen reports that suggest azathioprine is transferred into milk,  I have
not yet found the exact reference.

        Chronic immunosuppression with this product increases the risk of
neoplasia.  In addition,  infants are born partially immunodeficient
anyway.   This product is hepatotoxic, GI toxic, increases the risk of
infection, and is mutagenic in humans.

        This is one of those products that I believe simply too dangerous
for a breastfeeding mom to use.  Its just not worth the risk to the infant.
If therapy were short term,  mom could pump and dump,  however, it is
generally used long term and I would not recommend mom breastfeed without a
significant interruption.

        Sorry!

Tom Hale


Date:    Thu, 8 Feb 1996 07:02:43 -0500
 From:    "Mary Dour-O'Neill RN,IBCLC" <[log in to unmask]>
Subject: Azathioprine (Imuran)

Can a woman continue nursing her 5 1/2 month old infant if she is started
on
Azathioprine (Imuran).  There is no data re breastfeeding in Briggs,
Freeman,
& Yaffe (4th Ed.)  This mother was told she has to wean by her
Pediatrician.
 This baby was in our NICU for the first week of life because of a low
platelet count.  Now the baby is healthy and thriving.  Dr. Hale, do you
have
any data available?  Thank you.

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