Breast milk sulfasalazine

Lactation Sulfonamides are excreted in breast milk. In newborns, they compete with bilirubin for binding sites on the plasma proteins and may cause kernicterus. Children The safety and efficacy of sulfasalazine in pediatric patients younger than 2 years of age with ulcerative colitis have not been established. 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Pregnant colitic patients generally fare better if they continued to take aminosalicylates. Though sulfasalazine crosses the placenta, competes for albumin-binding sites with bilirubin, and can be detected in breast milk, no adverse effects on offspring have been detected. 

Recommendations for the use of drugs in nursing mothers vary. Although prednisone and prednisolone can be detected in breast milk, breast-feeding is believed to be safe for the infant when low doses of prednisone are used. Sulfasalazine does not pose a risk of ker-nicterus, as levels of sulfapyridine in breast milk are low or undetectable. Metronidazole should not be given to nursing mothers because it is excreted into breast milk. ... 

Systemically absorbed sulfasalazine is excreted chiefly in urine some parent drug and metabolites are excreted in breast milk. Plasma half-life is about 6 to 8 hours. 

---