Is Allopurinol safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Allopurinol. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Limited information indicates that a maternal dose of allopurinol of 300 mg daily provides near-therapeutic dose and plasma levels in an exclusively breastfed infant. The manufacturer recommends avoiding allopurinol during breastfeeding and for one week after the last dose. If the mother requires allopurinol, it is not a reason to discontinue breastfeeding, but exclusively breastfed infants should be monitored if this drug is used, including observation for allergic reactions (such as rash) and periodic CBC and differential blood counts.
Effects on the breastfed infant
One infant breastfed from age 1 week to age 7 weeks during maternal allopurinol therapy with 300 mg or allopurinol daily. The infant had no observable side effects and no changes in clinical chemistry and hematology values.[2]
A national survey of gastroenterologists in Australia identified 21 infants who were breastfed by mothers taking a combination of allopurinol and a thiopurine (e.g. azathioprine, mercaptopurine) to treat inflammatory bowel disease. All had taken the combination during pregnancy also. Two postpartum infant deaths occurred, both at 3 months of age. One was a twin (premature birth-related) and the other from SIDS. The authors did not believe the deaths were medication related.[3] No information was provided on the extent of breastfeeding, specific thiopurines, drug dosages or the outcomes of the other infants.
A single-center, retrospective study found 44 women with inflammatory bowel disease who had 62 pregnancies and 59 live births who took low-dose azathioprine in combination with allopurinol during pregnancy and postpartum. Eighty-four percent of their infants were breastfed and no serious signals or complications were reported first year of life.[4]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Allopurinol is metabolized to oxypurinol which has xanthine oxidase inhibitory activity equal to allopurinol's. Oxypurinol is absorbed well from the gastrointestinal tract.
Maternal Levels. A woman who was 5 weeks postpartum had been taking allopurinol 300 mg orally for 4 weeks. Two hours after a dose her breastmilk contained 0.9 mg/L of allopurinol and 53.7 mg/L of its active metabolite oxypurinol. Four hours after the dose, her breastmilk contained 1.4 mg/L of allopurinol and 48 mg/L of oxypurinol. The authors calculated that the exclusively breastfed infant would receive between 0.14 and 0.2 mg/kg of allopurinol and between 7.2 to 8 mg/kg of oxypurinol daily. This dose of oxypurinol is slightly less than the infant allopurinol dose of 10 mg/kg daily.[1,2]
Infant Levels. A 5-week-old infant whose mother had been taking allopurinol 300 mg daily for 4 weeks had plasma levels of allopurinol that was undetectable (<0.5 mg/L) and of oxypurinol that was 6.6 mg/L 2 hours after nursing and 4 hours after the mother's dose of allopurinol. This plasma level was 33 to 48% of the measured maternal plasma oxypurinol levels.[1,2]
Alternatives LactMed lists
Allopurinol in pregnancy
LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Allopurinol” (LM334). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.