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Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.
CASRN: 862111-32-8
Drug Levels and Effects
Summary of Use during Lactation
This record refers to the use of intravitreal aflibercept. Aflibercept inhibits vascular endothelial growth factor (VEGF). Aflibercept is a is a large protein molecule with a molecular weight of 115,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract, so systemic effects in infants are not expected. The manufacturer estimates that after intravitreal administration of 2 mg, the mean maximum plasma concentration of free aflibercept is more than 100-fold lower than the concentration of aflibercept required to half-maximally bind systemic vascular endothelial growth factor. Since VEGF is present in human milk and is thought to help in maturation of the infant’s gastrointestinal tract, concern has been raised about the maternal use of VEGF inhibitors during breastfeeding.[1] Note that the typical alternative to breastmilk is infant formula, which contains no VEGF.
Drug Levels
Maternal Levels. A woman with diabetic macular edema was given intravitreal aflibercept 2 mg one week postpartum. She was not breastfeeding her infant. Milk samples were obtained before the injection and on days 1-4 after the injection. Aflibercept was detected only on day 4 in a concentration of 10.9 mcg/L.[2]
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Relevant published information was not found as of the revision date.
Effects on Lactation and Breastmilk
A woman with diabetic macular edema was given intravitreal aflibercept 2 mg one week postpartum. She was not breastfeeding her infant. Milk samples were obtained before the injection and on days 1-4 after the injection. VEGF levels were reduced from 10.6 mcg/L at baseline to 4.9 mcg/L on day 1, where it remained for the next 3 days.[2]
Alternate Drugs to Consider
(Intravitreal) Bevacizumab, Ranibizumab
References
- 1.
- Dalal PJ, Patel AL, Carle M, et al. Review of ophthalmic and breastfeeding medicine evidence: Real and theoretical risks of intravitreal Anti-VEGF administration in lactating women. Retina. 2020;40:2065–9. [PubMed: 32796446]
- 2.
- Juncal VR, Paracha Q, Bamakrid M, et al. Ranibizumab and aflibercept levels in breast milk after intravitreal injection. Ophthalmology. 2020;127:278–80. [PubMed: 31526521]
Substance Identification
Substance Name
Aflibercept
CAS Registry Number
862111-32-8
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
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- Review Aflibercept: AVE 0005, AVE 005, AVE0005, VEGF Trap - Regeneron, VEGF Trap (R1R2), VEGF Trap-Eye.[Drugs R D. 2008]Review Aflibercept: AVE 0005, AVE 005, AVE0005, VEGF Trap - Regeneron, VEGF Trap (R1R2), VEGF Trap-Eye.. Drugs R D. 2008; 9(4):261-9.
- Aflibercept - Drugs and Lactation Database (LactMed)Aflibercept - Drugs and Lactation Database (LactMed)
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