Summary of Use during Lactation

No data exist on the medical use of rimabotulinumtoxinB during breastfeeding. However, it is not detectable systemically after intramuscular use, thus excretion into breast milk is considered unlikely. The closely related drug, onabotulinumtoxinA was not detectable in the milk of two women and detectable in only minute amounts in two others after 40 to 92 units injected into the face.[1] One infant was safely breastfed during maternal botulism and no botulinum toxin was detectable in the mother's milk or infant. Breastfeeding appears to protect infants against botulism.[2] No special precautions are required.

Drug Levels

Maternal Levels. Published information on the medical use of rimabotulinumtoxinB during breastfeeding was not found as of the revision date.

Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. She was given 2 vials of trivalent botulism antitoxin, 1 intravenously and 1 intramuscularly. A milk sample obtained 3 days after the onset of her illness and 4 hours after administration of botulinum antitoxin had no detectable botulinum toxin nor botulism organisms.[3]

Infant Levels. Type A botulinum toxin was detected in the blood and stools of a nursing mother after ingesting fermented salmon eggs. No botulinum toxin was detected in the breastfed infant's blood or stool on the day the mother was admitted to the hospital (3 days after the onset of illness) and no botulism organisms were detected in the infant's stools.[3]

Effects in Breastfed Infants

A woman developed botulism after ingesting fermented salmon eggs while breastfeeding her 8-month-old breastfed (extent not stated) infant. The infant developed no signs or symptoms of botulism even though she continued to nurse throughout the mother's hospitalization.[3]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Hudson C, Wilson P, Lieberman D, et al. Analysis of breast milk samples in lactating women after undergoing botulinum toxin injections for facial rejuvenation: A pilot study. Facial Plast Surg Aesthet Med 2024. [PubMed: 38306172]

2.

Arnon SS, Damus K, Thompson B, et al. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982;100:568-73. [PubMed: 7038077]

3.

Middaugh J. Botulism and breast milk. N Engl J Med 1978;298:343. [PubMed: 622098]

Substance Name

rimabotulinumtoxinB

CAS Registry Number

93384-44-2

Drug Class

Breastfeeding

Lactation

Milk, Human

Bacterial Toxins

Neuromuscular Agents

Neurotoxins