Is Plaquenil Safe in Breastfeeding

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

Antimalarial drug used as anti-inflammatory and immunomodulating agent on tissue diseases such as arthritis or lupus. It is excreted in breast milk in clinically non-significant amount which is much lower than the dose used in infants. Problems related to clinical features, development, vision or hearing issues have not been observed in infants whose mothers have received this medication. When the mother takes 400 mg per day only 1 mg appears for every liter of milk, which is not considered dangerous to the infant, since a preventive dose for malaria in infants is 5 mg per kilo of weight once a week. American Academy of Pediatrics states that it is usually compatible with breastfeeding medication.

Infants exposed to Plaquenil during breastfeeding receive only small amounts of the drug in breastmilk. In a small number of infants up to at least 1 year of age, careful follow-up found no adverse effects on growth, vision or hearing.[1][2] International experts indicate that Plaquenil is acceptable during breastfeeding.[3][4][5][6] When given once weekly for malaria prophylaxis, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. Breastfeeding infants should receive the recommended dosages of Plaquenil for malaria prophylaxis.[7]

No adverse effects were reported in one 9-month-old breastfed infant whose mother was taking 310 mg Plaquenil base daily for 6 weeks.[9] Five mothers took Plaquenil 200 mg daily during pregnancy and breastfeeding, one for 30 months. Flash electroretinograms performed on the infants were normal.[1][14] Another group of investigators have reported numerous infants whose mother took Plaquenil during pregnancy and were breastfed during maternal Plaquenil use. An abstract reported 16 infants breastfed for 1 to 19 months and followed up at an average of 24 months (range 1 to 86 months) with no evidence of visual or hearing deficits.[15] In a letter they reported 8 breastfed infants followed up at 1, 6 and 12 months of age who had normal growth and development and who had thorough, normal eye examinations at 1 and 12 months of age.[16] In a case series, 13 mothers taking Plaquenil sulfate 200 mg daily breastfed their infants for an average of 2.8 months (range 1 to 6 months). None had evidence of retinal, motor or growth abnormalities during 12 months of follow-up. The authors conclude that the benefits of breastfeeding outweigh the risk of Plaquenil.[2] It appears that the 8 infants reported in the letter were included among the 13 infants in the case series, but it is unclear whether the 16 infants reported in the abstract were part of the case series.