How long after stopping Plavix (clopidogrel) do you need to wait before resuming breastfeeding?

Resuming Breastfeeding After Clopidogrel (Plavix) Discontinuation

Breastfeeding should be avoided while taking clopidogrel (Plavix) and can be safely resumed 7-10 days after discontinuation of the medication, which corresponds to the time needed for complete restoration of platelet function.

Rationale for Waiting Period

Clopidogrel is an antiplatelet medication that irreversibly inhibits platelet function. According to the American College of Chest Physicians guidelines, when interrupting clopidogrel, a 7-10 day period (corresponding to the platelet life span) is needed to restore normal platelet function 1. This pharmacological property has important implications for breastfeeding safety:

• Clopidogrel irreversibly binds to platelets, affecting them for their entire lifespan
• Complete restoration of platelet function requires generation of new platelets
• This process takes 7-10 days after discontinuation

Safety Considerations for Breastfeeding

The British Association of Dermatologists' guidelines specifically recommend that "breast feeding should be avoided in patients receiving biologic therapy" 1. While this guideline doesn't specifically address clopidogrel, the principle of avoiding medications that may pose risks to infants applies similarly.

The American College of Chest Physicians provides guidance on anticoagulants during breastfeeding but doesn't specifically address clopidogrel 1. However, they do recommend alternative anticoagulants for breastfeeding women when certain medications are contraindicated.

Clinical Decision Algorithm

1. Discontinue clopidogrel if breastfeeding is desired
2. Wait 7-10 days after the last dose before resuming breastfeeding
   • This allows for complete restoration of normal platelet function
   • This timeframe corresponds to the platelet life span
3. Monitor the infant after resuming breastfeeding for any unusual bleeding or bruising

Special Considerations

• Urgent need to breastfeed: If there is an urgent need to resume breastfeeding before the 7-10 day period has elapsed, consult with both a cardiologist and lactation specialist to weigh risks and benefits
• Maintaining milk supply: During the waiting period, mothers may pump and discard breast milk to maintain supply
• Alternative medications: If antiplatelet therapy is still required, discuss with a cardiologist whether aspirin might be a safer alternative during breastfeeding, as the American College of Chest Physicians suggests that low-dose aspirin may be continued during breastfeeding 1

Potential Risks of Premature Resumption

Resuming breastfeeding too soon after clopidogrel discontinuation could potentially expose the infant to:

• Active metabolites of the drug
• Increased risk of bleeding complications
• Unknown long-term effects on infant platelet function

The 7-10 day waiting period provides sufficient time for drug clearance and restoration of normal platelet function, minimizing any potential risks to the breastfed infant.