International Board of Certified Lactation Consultant (IBCLC) Practice Exam

Which drug commonly used for lupus is contraindicated during nursing?

1. Hydroxychloroquine

2. Azathioprine

3. Cyclophosphamide

4. Prednisone

The correct answer is: Cyclophosphamide

Cyclophosphamide is commonly recognized as contraindicated during nursing due to its potential toxicity and the risks it poses to a breastfeeding infant. This drug is a powerful immunosuppressant and chemotherapy agent often used in severe cases of lupus, particularly when the disease has systemic involvement or is life-threatening. The major concern with cyclophosphamide is that it can be excreted in breast milk, thereby exposing the nursing infant to the drug's effects, which can range from immune suppression to toxic adverse reactions. Given its potential to affect fetal development and newborn health significantly, it is crucial to avoid its use during lactation. In contrast, hydroxychloroquine, azathioprine, and prednisone have been assessed more favorably in terms of safety for breastfeeding. Hydroxychloroquine is generally considered safe during nursing, azathioprine has a relatively low transfer to breast milk and is regarded as low risk, and while prednisone does pass into breast milk, it is typically considered safe due to its short half-life and low dosage typically required to manage lupus. Thus, cyclophosphamide's significant risk profile makes it the drug that is contraindicated during nursing, necessitating careful evaluation and alternative treatment options for mothers who are breastfeeding.