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Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-.
CASRN: 2415933-40-1
Drug Levels and Effects
Summary of Use during Lactation
The distribution of casirivimab and imdevimab was stopped in January of 2022 because of a lack of efficacy against SARS-CoV-2 variants. Imdevimab is a monoclonal antibody given together with casirivimab. Both are directed against the SARS-CoV-2 virus that causes COVID-19. Casirivimab and imdevimab transiently increased anti-receptor-binding domain IgG titers in one woman. Because imdevimab is a large protein molecule, the amount in milk is likely to be very low.[1] It is also likely to be partially destroyed in the infant's gastrointestinal tract and absorption by the infant is probably minimal.[2]
Drug Levels
Maternal Levels. A nursing mother received the Pfizer-BioNTech COVID-19 vaccine about 1.8 months postpartum followed by the second dose in the primary series. From 60 day postpartum, she had a poor IgG antibody response against the receptor binding domain to the vaccine compared to a matched control woman. At day 216 postpartum, she tested positive for SARS-CoV-2 and on day 222, she received an intravenous infusion of casirivimab 600 mg and imdevimab 600 mg. Her milk anti-receptor-binding domain IgG titers increased markedly before returning to her baseline at about 560 days postpartum.[3]
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
An unvaccinated Japanese woman who was 36 weeks and 6 days pregnant developed COVID-19 and was given an intravenous dose of casirivimab and imdevimab (Ronapreve) for her COVID-19 infection. Her infant was born 5 days later and separated from her. Approximately 10 days after the dose, she began breastfeeding her infant. At 30 days of age, the infant was in good health.[4]
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
Alternate Drugs to Consider
References
- 1.
- Stratigakis A, Paty D, Zou P, et al. A regression approach for assessing large molecular drug concentration in breast milk. Reprod Breed 2023;3:199-207. doi:10.1016/j.repbre.2023.10.003 [CrossRef]
- 2.
- Anderson PO. Monoclonal antibodies during breastfeeding. Breastfeed Med 2021;16:591-3. [PubMed: 33956488]
- 3.
- Marshall NE, Blanton MB, Doratt BM, et al. Monoclonal antibody therapy of breastfeeding patient infected with SARS-CoV-2: A case report. Breastfeed Med 2023;18:626-30. [PMC free article: PMC10460680] [PubMed: 37615569]
- 4.
- Ogawa E, Goto H, Ushimaru H, et al. Vaginal delivery after improvement in COVID-19 by monoclonal antibody treatment: A case report and literature review. J Infect Chemother 2022;28:982-6. [PMC free article: PMC8898669] [PubMed: 35288022]
Substance Identification
Substance Name
Imdevimab
CAS Registry Number
2415933-40-1
Drug Class
Breast Feeding
Lactation
Milk, Human
Antibodies, Monoclonal
Antibodies, Viral
Antiviral Agents
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- Review Casirivimab.[Drugs and Lactation Database (...]Review Casirivimab.. Drugs and Lactation Database (LactMed®). 2006
- Review SARS-CoV-2-neutralising monoclonal antibodies to prevent COVID-19.[Cochrane Database Syst Rev. 2022]Review SARS-CoV-2-neutralising monoclonal antibodies to prevent COVID-19.Hirsch C, Park YS, Piechotta V, Chai KL, Estcourt LJ, Monsef I, Salomon S, Wood EM, So-Osman C, McQuilten Z, et al. Cochrane Database Syst Rev. 2022 Jun 17; 6(6):CD014945. Epub 2022 Jun 17.
- Review Etesevimab and Bamlanivimab.[Drugs and Lactation Database (...]Review Etesevimab and Bamlanivimab.. Drugs and Lactation Database (LactMed®). 2006
- High titer of antibody against the SARS-CoV-2 spike protein among patients receiving neutralizing antibody cocktail therapy with REGN-COV.[Infection. 2022]High titer of antibody against the SARS-CoV-2 spike protein among patients receiving neutralizing antibody cocktail therapy with REGN-COV.Sasaki H, Miyata N, Yoshimura Y, Tachikawa N. Infection. 2022 Jun; 50(3):771-774. Epub 2022 Feb 18.
- Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial.[Lancet. 2022]Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial.RECOVERY Collaborative Group. Lancet. 2022 Feb 12; 399(10325):665-676.
- Imdevimab - Drugs and Lactation Database (LactMed®)Imdevimab - Drugs and Lactation Database (LactMed®)
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