One of my recent areas of focus has been trying to figure out what, if any, medications I can take while I am breastfeeding. This is an area of concern for me and I wanted to share some of what I have found.

Let me start by saying that I am not claiming to be a medical professional and choosing to take medication while pregnant or breastfeeding is ultimately a decision that must be made by the mother along with her Doctors. My intent is to share my interpretation of the information that I have gathered. I will make an attempt to leave out my personal opinions on the subject and post them separately.

It is true that very little reseach has been done on the levels that many ADD drugs pass through to breast milk. However, there is at least one researcher that conducting studies and publishing data on this. Interestingly, he is currently looking for participants for a Ritalin study so hopefully there will be some published data on this in the near future.

Dr. Thomas Hale publishes a book called Medications and Mothers' Milk which is largely based on his own research. It is the only reference that I am aware of that specifically discusses the actual affect that different medications have on breast milk. This book is specifically targeted toward medical professionals and includes pharmacology information on several hundred different medications. In addition to prescription medications he covers over-the-counter meds, some herbal supplements and even some street drugs(obviously these are listed as Contradindicated).

This Dr also has a website http://neonatal.ama.ttuhsc.edu/lact/index.html There is additional information available here as well as a forum where medical professionals can request additional information on behalf of nursing mothers. Dr Hale generally holds the position that a drug that is needed in order for the mother to function at an appropriate level to care for her child(ren) (i.e. depression) is a situation where the benefit of continuing to breastfeed outweighs the risk to the childs exposure to the medications.

Now as far as ADD medications go the research is in the very early stages. Most of the data available on Stimulants is from mothers using street drugs. However, a few mothers have been studied with Ritalin and at least one with Adderall. The information available shows that the levels that pass through to the child would be quite low. Dr Hale suggests that any relative dosage less than 10% is probably within safe levels. The studies done on Ritalin and Adderall show no more than a 1.9% relative dosage passed to the infant. The relative infant dosage is calculated using a mathemetical equation which takes the weight of the child into consideration.

An excerpt from Dr. Hales book provides some points to consider:

Key Points About Breastfeeding and Medications


Avoid using medications where possible. Herbal drugs, high dose vitamins, unusual supplements, etc. are simply not necessary; recommend avoiding the risk.
If the Relative Infant Dose is less than 10%, most medications are quite safe to use. The RID of the vast majority of drugs is <1%.
Choose drugs for which we have published data rather than those recently introduced.
Evaluate the infant for risks. Be slightly more cautious with premature infants or neonates. Be less concerned about older infants.
Observe breastfeeding mothers for depression as the incidence is high.
Recommend antidepressants in depressed breastfeeding mothers. The risks of a depressed mother to the infants are simply too high.
Most drugs are quite safe in breastfeeding mothers while the risks of not breastfeeding and of using infant formulas are much higher for the infant.
Discontinuing breastfeeding for some hours/days may be required partiularly with radioactive compounds.
Choose drugs with short half-lives, high protien binding, low oral bioavailability, or high molecular weight.
Adapted from "Drug Therapy and Breastfeeding: From Theory to Clinical Practice"

Now I will post my personal opinions on this matter. Please do not take this as anything other than my personal opinion and is not intended in anyway to suggest that the choices of other mothers out there are better or worse than my own choices. I know that there is plenty of potential for controversy with this subject.

My son is 7 months old and is still breastfed almost exclusively. During my pregnancy I could sense that the addition of a second child to my life would push me right to the edge of my ability to handle day to day life. Since depression is the most common cause of such feelings I assumed that it was the cause of my feelings.

Depression never quite meshed with my experience so when I saw some information about the way that ADD looks in girls/women I had that familiar "aha" experience. It is an exhillarating feeling for me. But being aware of a problem does not solve the problem. The difficult job of dealing with the problem still lays ahead of me.

Knowing that taking medications while being the sole source of a very young childs nutrition is a little scary. It is frustrating to have so little data available on how medcations affect breastmilk. But the ethical concerns of conducting research that could affect the well being of children are very obvious.

On the other hand most Drs refer to sources such as the Physicians Desk Reference to determine which medications are safe for breastfeeding mothers. This book, as far as I have been able to determine is essentially a compilation of information which is largely provided by the pharmeceutical companies. These companies are rightfully concerned with litigation so in absence of real information will contraindicate many medications for use in breastfeeding mothers. What is written in this literature does not necessarily suggest that a medication is unsafe but really just means that nobody knows enough to make a solid determination.

This leaves mothers with very few options and even less real information on which to base decisions. If a medication is listed as safe then the choices are to either not recieve treatment for the condition or to discontinue breastfeeding.

My personal decision at this time has been to continue breastfeeding during my med trial of short acting ritalin. I attempt to time feedings so they do not coincide with times when the medication is not at peak levels in my system. I also watch my son carefully to see if there are any changes in his behavior and sleep patterns. My basis for this decision is that I feel that my need to get my condition under control for the benefit of myself and all of the members of my family outweighs the risk of my child being exposed to a very small amount of the medication.

Anyway thats where I am coming from, though, I am sure that there are those that would disagree.

Have you noticed any changes in your son while on the medication? My daughter is now 1 (yesterday) Yippy!!! She is still almost exclusively nursed and is 90% in weight (lil chubbsters) I took zoloft all through my pregnancy and nursing, now I have had strattera added to it, the only thing I have noticed and this maybe because I am actually looking for something is she will occasionally have shivers (my mother called them pee chills) sleep, behavior and appetite seems all to be fine.

Hi Lilgoomer. I have tried to watch my son's sleeping and eating since I started on Ritalin. It coincided pretty closely to the time he started on solid foods but he seems to be sleeping and eating fine. If anything he is sleeping better than before.

My "little" guy is around 95% in weight and height. If he goes down any I will reconsider the meds. But he seems to be doing just fine. I may see if I can get a trial of Slow Release form of Ritalin since the ups and downs get to me. I am also looking at Effexor as a possibility if I need to try a non-stimulant. It all depends on what the Dr I am seeing this Thursday has to say.

According to the information I have Strattera has 98% protein binding and a 5 1/2 hour half life. Dr Hale suggests short half life and high protien binding medications. Strattera seems to qualify on those two counts. There are reports of Strattera showing up in the milk of lab rats but Dr Hale also says that med levels in rats is almost always many times higher than in humans.

I wish there were some other perspectives and researchers working in this area but I have not come across any. I was thinking about weaning my son but I decided last night that I just can't do it. He won't take a bottle anyway so even if I wanted to it would not really work too well. LOL

It is good to see you sticking to the nursing!! I also sort of wondered if we have the chemical deficiancy and ADD is hereditary maybe that tiny bit that may come through in our milk would actually benefit our babies? Just a bit of speculating on my part. My daughter is my 5th child and the first that I was diagnosed with acute long term depression and now ADD. I was not treated with the four and now my 7 yo is in the process of being evaluated for ADD :p Poor kid, gets dyslexia from his dad and ADD from his mom....

BS"D

Hi! I am doing research on breastfeeding and ADD medications as well. I have been in touch by e-mail with Dr. Hale as well as with Dr. Newman, and both have said that I should at least be able to try the medication while breastfeeding. Now here's the thing: I have to get a psychiatrist to give me an Rx. That's my big hangup. I have been told since I was trying to get pregnant that I would not be able to have drugs during pregnancy, and then after I gave birth I was told that nobody would risk letting me take anything during breastfeeding either. I really would love if anyone knows of a Psychiatrist in the Twin Cities who would be willing to work with me, and who accepts Health Partners insurance. I don't want to put my baby in any unnecessary risk! I will be absolutely vigilant about watching for any side effects in the baby. On the other hand, I want my marriage and my happiness to be around while my daughter grows up. I need my medication, and if I can't get it by telling the truth, then I feel I may be forced to lie to a psychiatrist about breastfeeding.