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Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.

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Drugs and Lactation Database (LactMed) [Internet].

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Diroximel fumarate

Last Revision: February 20, 2022.

Estimated reading time: 1 minute

CASRN: 1577222-14-0

image 393666646 in the ncbi pubchem database

Drug Levels and Effects

Summary of Use during Lactation

No information is available on the clinical use of diroximel fumarate during breastfeeding. However, amounts of the active metabolite of diroximel fumarate, monomethyl fumarate, in breastmilk appear to be low and would not be expected to cause any adverse effects in breastfed infants. Breastfed infants should be monitored for adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. Some authors also recommend monitoring breastfed infants for flushing, vomiting and diarrhea.[1,2]

Drug Levels

Diroximel fumarate is not found in the plasma because it is rapidly converted to the active drug, monomethyl fumarate, which has a half-life of about 1 hour.

Maternal Levels. Two nursing mothers with relapsing-remitting multiple sclerosis began the closely related drug dimethyl fumarate 240 mg orally twice daily after discontinuing breastfeeding. They continued pumping milk and on day 8 of therapy, they each provided milk samples at 1, 2, 4, 8 and 12 hours after a dose. Peak monomethyl fumarate milk levels were 3.7 mcg/L in one mother and 11.2 mcg/L in the other and occurred at about 2 hours after the dose. Average milk levels were 2.7 mcg/L and 7.5 mcg/L, respectively. These values indicate that the infants would receive daily dosages of about 0.8 mcg/kg and 1.13 mcg/kg, respectively, or weight-adjusted relative infant dosages of 0.007% and 0.019% of the maternal dosage.[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

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

Alternate Drugs to Consider

(Multiple Sclerosis) Glatiramer, Immune Globulin, Interferon Beta

References

1.
Almas S, Vance J, Baker T, et al. Management of multiple sclerosis in the breastfeeding mother. Mult Scler Int. 2016;2016:6527458. [PMC free article: PMC4757692] [PubMed: 26966579]
2.
Ciplea AI, Datta P, Rewers-Felkins K, et al. Dimethyl fumarate transfer into human milk. Ther Adv Neurol Disord. 2020;13:1756286420968414. [PMC free article: PMC7607748] [PubMed: 33193814]

Substance Identification

Substance Name

Diroximel fumarate

CAS Registry Number

1577222-14-0

Drug Class

Breast Feeding

Lactation

Dermatologic Agents

Immunosuppressive Agents

Radiation-Sensitizing Agents

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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