Is Tranexan Safe in Breastfeeding

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

Anti-fibrinolytic drug that is used on the treatment and prophylaxis of hereditary angioedema, menorrhagia and other hemorrhagic disorders. It is excreted into breast milk in a non-significant amount: the concentration measured in the milk was 1% of plasma concentration (Verstraeten 1985, WHO 2010, Caballero 2012).Despite of that low observed concentration, an expert consensus did not recommend its use while breastfeeding (Caballero 2012). No clinical or developmental issues have been observed in the short and long term among 21 infants whose mothers were treated with it. (Gilad 2014). Scientific societies and some consensus of experts believe it is compatible the use of Tranexan during breastfeeding (WHO 2010, Bouillet 2015).

Amounts of Tranexan in breastmilk appear to be low. Although an international consensus panel recommended against using Tranexan during breastfeeding,[1] a subsequent controlled study found no adverse outcomes among breastfed infants whose mothers took Tranexan in dosages up to 4 grams daily during breastfeeding. One center in Canada reports routine use of Tranexan 3 grams daily in nursing mothers with bleeding disorders until bleeding stops.[2] If Tranexan is required by a mother, it is not a reason to discontinue breastfeeding; however, until more data become available, medical supervision and follow-up of the breastfed infant is recommended.[3]

Twenty-one mothers who took Tranexan during breastfeeding were compared to 42 mothers who took amoxicillin during breastfeeding. In the study population, the Tranexan dosage ranged between 1.5 and 4 grams daily at an average of 4.2 months of age and 81% exclusively breastfed their infants. The average time of follow-up of the infants of study mothers was 35.7 months of age. No statistically significant difference were found between the study and control groups in possible drug side effects, neurological development or general health.[3] A randomized, double-blind, multicenter study compared the use of a 1 gram dose of intravenous Tranexan (n = 10,051) to placebo (n = 10,009) in women with postpartum hemorrhage. The dose could be repeated in 24 hours if bleeding recurred. Among babies who were breastfed, no difference in infant deaths were seen between the two groups, nor were any thromboembolic events reported. The numbers of breastfed infants in each group were not reported.[5]