Is Ranibizumab Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Ranibizumab? Is Ranibizumab safe for nursing mother and child? Does Ranibizumab extracts into breast milk? Does Ranibizumab has any long term or short term side effects on infants? Can Ranibizumab influence milk supply or can Ranibizumab decrease milk supply in lactating mothers?

Human-like monoclonal antibody (IgG1 immunoglobulin) produced by DNA recombinant technology. Action is by blockage of endothelial growth factor. Has been used for treatment of several types of cancer. Useful for treatment of eye macular degeneration secondary to choroidal neovascularization. Because of a high molecular weight and a protein structure, excretion into breast milk and absorption by infant's gut are highly unlikely. Intravitreal injection: because small doses used and low level observed in the plasma and because neither trace in breast milk nor side-effects in the infant have been reported, treatment is likely safe while breastfeeding. It has advantage over Bevacizumab because it does not inhibit Vascular Endothelial Growth Factor (VEGF) that is present in the breast milk. No harmful effects on infants from treated mothers have been reported.

Because ranibizumab is a large protein molecule with a molecular weight of 48,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. One infant was breastfed, apparently without noticeable harm, following maternal intravitreal ranibizumab injections. Vascular endothelial growth factor (VEGF) levels in breastmilk were not changed following the injection. Because the breast and neonatal intestine have VEGF receptors, some authors recommend use of intravitreal ranibizumab over bevacizumab, which does appear to depress milk VEGF levels.[1] Ranibizumab is a human immunoglobulin G1 (IgG1) kappa antibody. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G by up to 79%.[2][3] A study of 67 colostrum samples that underwent Holder pasteurization found that IgG amounts decreased by 34 to 40%. Specific IgG subclasses decreased by different amounts, with IgG1 activity decreasing by about 37%.[4] None of the studies measured IgG activity.