Is Sugammadex safe while breastfeeding?

Summary of use during breastfeeding

Negligible amounts of sugammadex are excreted into breastmilk after usual doses. Because sugammadex is a large, highly polar molecule with a molecular weight of 2002 Da, oral absorption by the infant is unlikely. Sugammadex is acceptable to use during breastfeeding.[1-3]

Effects on the breastfed infant

Relevant published information was not found as of the revision date.

Effects on milk supply

A study compared sugammadex to neostigmine in their effects on lactation-related hormones in women undergoing cesarean section surgery under general anesthesia. Both groups showed significant decreases in progesterone and estradiol levels after surgery compared to preoperative values; however, the sugammadex group exhibited a significantly greater decrease. Aldosterone levels reached their highest point at the end of surgery, but by 4 hours later they were lower than before surgery, especially in the sugammadex group. Cortisol showed a temporary postoperative elevation, whereas prolactin and oxytocin levels rose in both groups, with no significant intergroup variations.[5]

Levels in milk

Maternal Levels. Women undergoing cesarean section who received general anesthesia and neuromuscular block with rocuronium donated breastmilk samples at one (n = 8) and six (n = 8) hours following sugammadex administration in a median dose of 2.56 mg/kg. All patients received a 200 mg dose, and one received an additional 200 mg dose in the PACU. Of the eight 1-hour samples, sugammadex was undetectable in seven breastmilk samples and unquantifiable (<1 mg/L) in one sample. Of the eight samples obtained at 6 hours, sugammadex was undetectable in seven breastmilk samples and unquantifiable (<1 mg/L) in one (12.5%) sample.[4]

Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Neostigmine