Is Temozolamide Safe in Breastfeeding

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

Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as temozolamide.[1] It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, no data are available to determine an appropriate period to withhold breastfeeding. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.

A woman diagnosed with Hodgkin's lymphoma during the second trimester of pregnancy received 3 rounds of chemotherapy during the third trimester of pregnancy and resumed chemotherapy 4 weeks postpartum. Milk samples were collected 15 to 30 minutes before and after chemotherapy for 16 weeks after restarting. The regimen consisted of doxorubicin 40 mg, bleomycin 16 units, vinblastine 9.6 mg and dacarbazine 600 mg, all given over a 2-hour period every 2 weeks. The microbial population and metabolic profile of her milk were compared to those of 8 healthy women who were not receiving chemotherapy. The breastmilk microbial population in the patient was markedly different from that of the healthy women, with increases in Acinetobacter sp., Xanthomonadacae and Stenotrophomonas sp. and decreases in Bifidobacterium sp. and Eubacterium sp. Marked differences were also found among numerous chemical components in the breastmilk of the treated woman, most notably DHA and inositol were decreased.[2]