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Ativan & Nursing? Help

Posted by on Aug. 22, 2013 at 12:49 AM
  • 6 Replies

I was prescribed Ativan for my anxiety attacks, only when they get extremely severe. Has anyone else taken this while nursing? I read that it peaks in breastmilk 2 hours after you take it and that's when you should avoid nursing. I'm terrified to take it. Honestly would probably make my attack worse if I sit there and contemplate whether to take it or not. 

I don't have many options left for managing my anxiety and breastfeeding. My mom really keeps pushing that I should go back on Cymbalta which is not approved for breastfeeding and formula feed her. But that is absolutely not going to happen until I've exhausted all my options. I just want whats best for my baby and I don't want any of this drug getting into her system. How can I safely do this? 

Soo confused because some websites say "no special precautions are required" and others say that "it's recommended women stop breastfeeding while taking it" 

My doctor/ob is on maternity leave and won't be back until mid-october and I had to see a different doctor so I really didn't get much explanation on how to go about this. Any help/advice is appreciated! Thank you!

by on Aug. 22, 2013 at 12:49 AM
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melindabelcher
by mel on Aug. 22, 2013 at 7:29 AM
This is for Cymbalta





Summary of Use

Little published information is available on the use of duloxetine during breastfeeding; however,the dose in milk is low and serum levels were low in two breastfed infants. An alternate drug that has been better studied may be preferred,especially while nursing a newborn or preterm infant. If duloxetine is required by the mother,it is not a reason to discontinue breastfeeding. Monitor the infant for drowsiness,adequate weight gain,and developmental milestones,especially in younger,exclusively breastfed infants and when using combinations of psychotropic drugs.

Drug Levels

Maternal Levels. Sixlactating women who were at least 12 weeks postpartum and weaning their infants were given duloxetine 40 mg with food every 12 hours for 3.5 days. Milk samples from both breasts were obtained before and at 1,2,3,6,9 and 12 hours after the dose on day 4. Peak milk duloxetine levels occurred at an average of 6 hours after the dose. The amount of duloxetine excreted into breastmilk was approximately 7.4 mcg (range 3.6 to 15 mcg) daily in these women. The normalized milk excretion corresponded to an infant dosage of 0.2 mcg/kg/day or 0.14% (maximum 0. 0.25%) of the weight-adjusted maternal dosage. The excretion of duloxetine metabolites,which are inactive,into breastmilk was not studied.[1]

A woman took oral extended-release duloxetine 60 mg daily (868 mcg/kg/day) during pregnancy and breastfeeding. On day 32 postpartum,milk samples were obtained 10 minutes and 6 hours after the dose. The first (trough) sample contained 31 mcg/L of duloxetine and the second (peak) sample contained 64 mcg/L. The authors calculated that an exclusively breastfed infant would receive a dose of 7.1 mcg/kg daily at this maternal dosage,corresponding to 0.82% of the weight-adjusted maternal dosage.[2]

A woman with recurrent depression took duloxetine 60 mg daily throughout pregnancy and breastfeeding. At 18 days postpartum,the mother collected milk samples before the daily dose and at 8 more times during the next 22.5 hours. The peak milk concentration occurred at about 7 hours after the dose. The average milk concentration over the 24-hour dosage interval was 51 mcg/L. Hindmilk concentrations were somewhat higher than foremilk concentrations at the 2 times when they were measured separately. The authors estimated that the infant received a duloxetine dose of 0.81% of the mothers weight-adjusted dose via breastmilk.[3]

Infant Levels. An infant whose mother was taking oral extended-release duloxetine 60 mg daily was exclusively breastfed. On day 32 of life,a blood sample was obtained 4 hours after the last nursing which was 8 hours and 15 minutes after the mother's previous dose. Duloxetine was undetectable (<1 mcg/L) in the infant's plasma.[2]

An infant was breastfed (extent not stated) by a mother taking duloxetine 60 mg daily. At 18 days of age,the infant's plasma concentration was 0.82% that of the mother's plasma level at 7.6 hours after the mother's dose.[3]

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

Effects on Lactation In a small prospective study,8 primiparous women who were taking a serotonin reuptake inhibitor (SRI; 3 taking fluoxetine and 1 each taking citalopram,duloxetine,escitalopram, paroxetine or sertraline) were compared to 423 mothers who were not taking an SRI. Mothers taking an SRI had an onset of milk secretory activation (lactogenesis II) that was delayed by an average of 16.7 hours compared to controls (85.8 hours postpartum in the SRI-treated mothers and 69.1 h in the untreated mothers),which doubled the risk of delayed feeding behavior in the untreated group. However,the delay in lactogenesis II may not be clinically important,since there was no statistically significant difference between the groups in the percentage of mothers experiencing feeding difficulties after day 4 postpartum.[4]

After one nonpregnant woman began taking duloxetine,her serum prolactin increased and previous galactorrhea,which had decreased after stopping venlafaxine,increased again. After stopping duloxetine,her prolactin decreased to normal and galactorrhea ceased.[5]

Alternate Drugs Sertraline,Nortriptyline,Paroxetine

Drug Class Antidepressive Agents

Antidepressants

Adrenergic Uptake Inhibitors

Serotonin Uptake Inhibitors
melindabelcher
by mel on Aug. 22, 2013 at 7:30 AM
And this is Ativan





Summary of Use

Lorazepam has low levels in breastmilk,a short half-life relative to many other benzodiazepines,and is administered directly to infants. Lorazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.

Drug Levels

Maternal Levels. Four women were given 3.5 mg of lorazepam orally 2 hours before undergoing cesarean section. Colostrum levels of lorazepam averaged 8.5 mcg/L at 4 hours after the dose; conjugated lorazepam metabolites were not measured.[1]

Another woman taking 2.5 mg orally twice a day for the first 5 days postpartum had milk levels of free and conjugated lorazepam of 12 and 35 mcg/L,respectively,at an unspecified time on day 5.[2] Since infants can deconjugate and absorb glucuronides,the total drug level is probably more important than the free drug alone. Using the total amount excreted,an exclusively breastfed infant would receive about 7 mcg/kg daily with this maternal dosage or about 8.5% of the maternal weight-adjusted dosage.

A woman who was 4 weeks postpartum was taking lorazepam 2.5 mg 1 to 3 times daily and lormetazepam,which is partially metabolized to lorazepam,2 mg once daily. On day 5 of therapy after taking 2 doses of lorazepam in the previous 8 hours,her lorazepam milk level was 123 mcg/L. On day 6 after having taken 3 doses in the previous 24 hours,her milk lorazepam level was 89 mcg/L. On day 7,milk levels were 55 and 40 mcg/L at 14 and 18.5 hours after her last dose,respectively.[3]

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

Effects in Infants In one case,the newborn infant of a mother taking 2.5 mg of lorazepam orally twice daily for 5 days after delivery showed no signs of sedation.[2]

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

Alternate Drugs Midazolam,Oxazepam

Drug Class Hypnotics and Sedatives

Anti-Anxiety Agents

Benzodiazepines
melindabelcher
by mel on Aug. 22, 2013 at 7:31 AM
Ativan is definetly fine. The cymbalta is a proceed with caution with young infants not a discontinue bf.
amberlavine
by Member on Aug. 22, 2013 at 11:19 AM

Thank you! I think this is one of the websites that I found with the info. It's hard for me to understand the breakdown in breastmilk when they explain it. The ativan is only as needed so I really can't see me even taking it once daily. Probably once every 3 or 4 days if that. Only when they get really bad. They were pretty no-no on the Cymbalta while breastfeeding so I'm on Zoloft right now to see if that works for me. Which I hope that it does! 


Quoting melindabelcher:

Ativan is definetly fine. The cymbalta is a proceed with caution with young infants not a discontinue bf.



amberlavine
by Member on Aug. 22, 2013 at 11:20 AM
1 mom liked this

Also my dosage of Ativan is only 0.5mg and I see that the others were on a higher dosage than mine, more than once a day and no signs of sedation. 

maggiemom2000
by Ruby Member on Aug. 22, 2013 at 4:37 PM
1 mom liked this

LORAZEPAM (Ativan)

The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2012.  He assigns every drug a lactation risk category:  L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. Possible risks to mother and baby are listed as well as possible effect on milk supply.


For more info you can call Dr. Hale’s InfantRisk hotline at (806) 352-2519

www.infantrisk.org

Listed as L3, moderately safe; pediatric concerns: None reported via milk, but observe for sedation. “It would appear from these studies that the amount of lorazepam secreted into milk would be clinically insignificant under most conditions.”

The decision about continuing breastfeeding when the mother takes a drug is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother and the baby. And there are plenty of risks in not breastfeeding, so the question essentially boils down to:  Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than exclusive formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. Dr, Jack Newman http://www.breastfeedinginc.ca/content.php?pagename=doc-B-M

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