From the Guidelines
Breastfeeding individuals with COVID-19 can safely take Paxlovid (nirmatrelvir/ritonavir) as the potential benefits of treatment outweigh the theoretical risks to the infant. According to the World Health Organization (WHO) living guideline on drugs for COVID-19 1, breastfeeding people with non-severe COVID-19 may consider using nirmatrelvir/ritonavir. The guideline suggests that the benefits of treating COVID-19 with Paxlovid outweigh the potential risks associated with breastfeeding.
Key points to consider when taking Paxlovid while breastfeeding include:
- The active components of Paxlovid are likely to be present in breast milk in small amounts
- Poor oral absorption in infants means minimal drug would enter the baby's bloodstream
- Ritonavir, a component of Paxlovid, has been used safely for years in breastfeeding individuals with HIV
- It is essential to discuss your specific situation with your healthcare provider, considering your COVID-19 severity, risk factors, and other medications you may be taking that could interact with Paxlovid
While there is limited specific data on Paxlovid in breast milk, the available evidence suggests that the medication can be used safely during breastfeeding 1. Breastfeeding individuals can continue to breastfeed normally while taking Paxlovid, and the medication consists of two medications: nirmatrelvir and ritonavir, taken as three pills twice daily for five days.
From the FDA Drug Label
Nirmatrelvir and ritonavir are present in human breast milk in small amounts (less than 2%). In a clinical lactation study in 8 lactating women, nirmatrelvir and ritonavir were estimated to be present in human milk at a mean weight-normalized infant daily dose of 0.16 mg/kg/day (1.8% of maternal weight-adjusted daily dose) and 0.006 mg/kg/day (0. 2% of maternal weight-adjusted daily dose), respectively... The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for PAXLOVID and any potential adverse effects on the breastfed infant from PAXLOVID or from the underlying maternal condition.
Safety of Paxlovid during breastfeeding:
- There are limited data on the effects of nirmatrelvir or ritonavir on the breastfed infant.
- The drug is present in breast milk in small amounts.
- Caution is advised when taking Paxlovid during breastfeeding, as the potential adverse effects on the breastfed infant are not well understood.
- The decision to use Paxlovid during breastfeeding should be made after considering the mother's clinical need for the drug and the potential risks to the infant 2.
From the Research
Safety of Paxlovid during Breastfeeding
There are no research papers provided that directly address the safety of taking Paxlovid (nirmatrelvir/ritonavir) during breastfeeding.
Available Information on Paxlovid
- The provided studies focus on the efficacy and safety of Paxlovid in treating COVID-19 in various patient populations, including high-risk, nonhospitalized adults 3, 4, 5, 6, 7.
- These studies report on the reduction of hospitalization and death rates, as well as the safety profile of Paxlovid, but do not mention its use during breastfeeding.
- As a result, there is no available evidence from these studies to inform the safety of taking Paxlovid during breastfeeding.