Safe Medications To Take While Breastfeeding

Breastfeeding is one of the best ways to provide a healthy start for your baby. The benefits are well researched. Unfortunately, the postpartum period is a dangerous time for bipolar mothers. Bipolar disorder can even be triggered by childbirth. There is a 50% chance of relapse during the postpartum period, primarily into depression, but there is also a significant risk for hypomania or mania. Fortunately, there are safe medications to take while breastfeeding.

Medication should only be taken if the benefits outweigh the risks of exposure to the infant. All psychotropic medications studied enter breastmilk. It’s just a matter of how much will pass to your baby. Medications that have a 10% or less exposure rate–how much of the maternal dose is passed to the infant–are deemed “safe”, or at the very least safer.

breastfeeding

Credit to flickr.com user myllissa. Used with permission under a Creative Commons license.

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are largely considered safe for breastfeeding mothers and their babies. A great deal of the research on medication use during breastfeeding is concentrated on SSRIs. Of the tricyclic antidepressants (TCAs), paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) have a limited exposure to newborns. There have only been a few cases where infants showed adverse effects to antidepressants.

Anti-anxiety agents exhibit similar results to antidepressants, with a great deal of the data pointing to few adverse reactions in infants, and low exposure rates. Many mood stabilizers, on the other hand, are secreted in high amounts in breastmilk and show a risk for toxicity in infants. There is very limited data on antipsychotics, especially atypical antipsychotics, but olanzapine, Risperidone (RisperiDAL), and quetiapine (Seroquel) show promising results.

Here are some of the most common choices for breastfeeding mothers:

Lithium

Lithium is concentrated in breastmilk–secreted between zero and 30% of maternal dosage–and there is a risk of lithium toxicity in in infants, so breastfeeding is discouraged unless the mother doesn’t respond to other medications on the market. A 2000 case review reported lithium toxicity in two cases out of eleven. Symptoms of toxicity include hypothermia, poor muscle tone, and lethargy. The pediatrician will take blood draws to monitor the baby’s thyroid, creatinine, and blood urea nitrogen (BUN) every six to eight weeks.

Olanzapine

Breastfeeding while taking Olanzapine has been studied much more than other medications due in part to a database collected by the manufacturer. There was a study which reported that the exposure rate is roughly 1.8%. Adverse reactions showed up in 15.6% of the babies, including tremor, insomnia, and irritability.

Quetiapine (Seroquel)

Quetiapine does not easily pass through breastmilk, with studies reporting 0.09% of the maternal dosage excreted. Unfortunately, a study found that one third of the babies reviewed showed some neurodevelopmental delay, but the mothers were taking other medications at the time, so no one knows for sure if it was the quetiapine that contributed.

Lamotrigine (Lamictal)

Lamictal is considered one of the safer medications for breastfeeding mothers, despite a study measuring up to 9.2% of the maternal dosage in breastmilk. The only adverse effect reported was thrombocytosis. The downside with Lamictal is that it takes four to six weeks to reach a therapeutic dose, so doctors recommend that medication use starts during the pregnancy.

Valproic acid (Depakote)

Depakote is also considered safe for breastfeeding. Only 1.7% of the maternal dosage passes into breastmilk due to its high plasma protein binding. Some adverse effects, such as liver damage, have been reported. However, because pediatricians prescribe Depakote to children, it has been deemed compatible with breastfeeding.

Risperidone (RisperiDAL)

Approximately 2.3% to 4.7% of the maternal dosage of Risperidone is secreted through the breastmilk, and no adverse effects have been reported in infants.

All medications taken while breastfeeding will be closely monitored by the baby’s pediatrician, especially lithium. Medication should only be considered for a breastfeeding mother after all of the risks have been discussed. In most cases, stability in the postpartum mother outweighs the risks of medication to the infant.

Did you take any medications while breastfeeding? Why or why not?

[Editor’s note: I could not have written this post without the invaluable article, “What to Tell Your Bipolar Patient Who Wants To Breastfeed,” by Wende Wood.]

Advertisements

About Cassandra Stout

Freelance writer Cassandra Stout blogs at The Bipolar Parent, a comprehensive resource for parents with mental illnesses. She is currently working on Committed, her forthcoming memoir detailing her time spent in a mental hospital while separated from her husband and newborn. Cassandra holds degrees from the University of Arizona in Creative Writing and Journalism, and is a member of the Pacific Northwest Writers Association. She balances her literary work with raising her children, feeding her cat, and managing her bipolar disorder.
This entry was posted in bipolar parent and tagged , , , , , , , , , , . Bookmark the permalink.

16 Responses to Safe Medications To Take While Breastfeeding

  1. dyane says:

    What a fabulous, informative post, Cass!

    I wish I had been able to read this article in 2007 when I had a newborn, I was diagnosed with postpartum bipolar, and was tandem breastfeeding my baby and toddler. This info. would’ve been a godsend.

    This would be a great post for the International Bipolar Foundation’s blog. Have you considered sending anything like this to them? Check out this link:

    http://www.ibpf.org/webform/blogging-application

    You could also contact BP Magazine’s blog:

    To apply, visit: http://www.bphope.com/bphope-blogging-application/

    These are just thoughts off the top of my head.
    Your blog rocks!!

    Xo
    Dy

    • Thank you so much for reading and making suggestions, Dyane! I hesitate to submit this post anywhere because I lifted so much information from the article I linked at the bottom. I took the statistics from there and made it more readable, so I don’t know if I’m toeing the line on plagiarism or not. We’ll see. Thanks again for the suggestions. I really appreciate your support!

      Have a great Friday!
      ❤ Cass

      • dyane says:

        I figured that could be a concern….I totally understand. Well, if not this post, then perhaps a future post, because your writings would help many! When your book comes out it should be profiled by both the IBPF & BP Magazine. Let me know when you need contact info. for those, if you want that – forgive me., I sound like such a bossy b*tch, LOL! Not to make excuses, but that lovely time of the month shall happen any day now! I’m turning 47, but there are no signs of that disappearing yet. Bummer!!!!!!!

        • I absolutely would like contact information for those! Thank you! And you’re not being bossy at all. I’m sorry you have your Aunt Flo coming up. That’s never fun. Sorry I replied to this twice; I placed the reply in the wrong spot!

          • dyane says:

            We shall keep in touch and I’ll happily give you that info. whenever you’re up for it. I’m glad I didn’t scare you away with my ‘tude -it could be worse! 😉 Take care & have a good Saturday, Cass! p.s. Today’s PostPartum Post shared this post – hurrah! I don’t know how it figures out what to share, but obviously it has excellent taste!

  2. Raegina says:

    Thanks for this post Cassandra. I think there is more positivism in the US around BF on medication than in Aus. So far I’ve only been told no – I didn’t even know that people BFd on lithium. I was just told no. Thanks for this,and I love the link to Wendy’s post.

    • Hi, Raegina,
      I don’t know much about breastfeeding on medication in Australia, but I’m sorry that you were told no. People do breastfeed on lithium, but only if they’re in a desperate situation and don’t respond to other medications on the market. I hope you’ll be allowed to breastfeed! Best of luck,
      Cass

  3. I wish some doctors were this informed. After the birth of my children, I had to buy the latest copy of “Medications and Mothers Milk” by renowned Dr. Thomas W. Hale, Ph.D., who has done extensive research on the subject, just to show to my doctors what was safe for me to take! (I was refused prescriptions for both Seroquel and Lamictal, only to research and read that they were known to be relatively safe for breastfeeding mothers and babes. That’s when I went searching for a new doctor!)

    Excellent information!

  4. Computer says:

    org/webform/blogging-application
    You could also contact BP Magazine’s blog:
    To apply, visit: <a href="http://www. !

  5. markmhamann says:

    !
    I wish I had been able to read this article in 2007 when I had a newborn, I was diagnosed with postpartum bipolar, and was tandem breastfeeding my baby and toddler.

Share Your Thougts!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s