My wife has extreme post-partum anxiety and thought it was just the "baby blues" but had a breakdown this weekend at 5 weeks post-partum. i am trying hard to get her to a psychiatrist but the soonest appoitnment is in three days. Can she take one or two xanax (.25 dosage) the next two days and an ambien at night and continue breastfeeding? or is there risk to the baby of three days of this routine? if not okay, how long do we have to pump and dump for after the xanax?
At 5 weeks there is probably minimal risk to the infant as long as he/she doesn't have problems with apnea. These drugs may sedate the infant slighly, but only about 8 % of alprazolam(Xanax) gets to the infant. When she speaks with her doctor, she might suggest Ativan (Lorazepam) instead, as levels are much lower (about 2.9%), but this selection is of course up to her physician.
About 5-20 percent of Ambien(Zolpidiem) transfers into milk. Zolpidem transfer to milk is variable but moderately high. It is probably okay to use during breastfeeding. One case of infant sedation and poor appetite related to zolpidem use has been reported following the nightly use of sertraline (100mg) and 10 mg Zolpidem. Use of sedatives in breastfeeding mothers is of some concern, particularly those with premature or young neonates, and those with weak infants. This drug should be avoided in mothers with infants subject to apnea. Zopiclone or eszopiclone are preferred sedatives in breastfeeding.
Tom Hale Ph.D.
The safety of these products depends to some degree on the age of the infant (older is better, younger or premature less so). It also depends on the health of the infant, you would not want to use these products in an infant with apnea or breathing difficulties.
Most infants do just fine with these medications as the amount that gets into milk is relatively low. Just advise your pediatrician what she is taking, and watch the infant closely for sedation, poor feeding, difficulty to arouse, all typical symptoms of the sedative effect of these drugs. I'm betting the infant will do fine.
As for brand name or generic, that depends on the manufacturer of the generic. Most are equivalent.
Tom Hale Ph.D.
I have the same issue but because of emetophobic. Our house just came down with the stomach flu and I've been having panic attacks for over a week now fearing I will get sick. I'm nursing a healthy 12 week old and Xanax does help. If I take intermittently how do you tell in a baby if sedation is a problem?
Alprazolam (Xanax) is probably safe to use during breastfeeding when used short-term, intermittently, and low dose after the first week of life. Observe your infant for sedation, poor feeding, irritability, crying, and withdrawal symptoms. Poor feeding and difficulty to arouse your infant would indicate sedation. The usual adult dose is 0.5 to 1 mg daily. The time the medication is highest in your system is the first 2 hours after your dose so try to avoid that time to decrease risk to your infant. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center