Migraines while breastfeeding

[shellyp22]

I currently have a 10 week old daughter. I have been taking vicodin frequently to help with migraines. Can vicodin build up in my daughter's system? I have probably taken 1 a day since she has been born. (technically not every day but throughout the 7 days would equal to one a day. if that makes sense) I usually take it after a feeding and then pump/dump at the next session, so sometimes if it is at night she does not feed again until 8 hours after taking it. If I have to take it often am I better off to switch to formula? I just don't want to harm her and these migraines have been terrible. I try to stay away from imitrex which is why I am taking the vicodin, but last week had to take 3 imitrex in 48 hours. So I pumped and dumped for 24 so the imitrex was minimal? She is a great nurser and I would be so sad switching her but I just feel uncomfortable with taking a vicodin a day and still feeding her? The vicodin is 5 mg..

[cpride]

Dear shellyp22,

Vicodin is a combination of hydrocodone and acetaminophen (Tylenol). Only a small amount of the hydrocodone enters your breastmilk. Waiting 4 hours from your dose will allow one half-life (time it takes for half of the medication to be eliminated from your system) to pass. Since your child is 2 months of age, you should not exceed 40 mg of hydrocodone in 24 hours and not more than 3000 mg in 24 hours of acetaminophen. The time the medication will be highest in your breastmilk is one hour after you take your dose so avoid that time to decrease risk for your infant. Observe your infant for sedation. If noted, wait longer from your dose before breastfeeding again. Sumatriptan succinate (Imitrex) is also compatible with breastfeeding. Sumatriptan is a serotonin receptor agonist used for the treatment of migraine headaches. Dr. Hale recommends to wait at least 4 hours from an intramuscular injection of sumatriptan, and your flushing and dizziness have resolved, before returning to breastfeeding. If you take oral Imitrex, then you should wait at least 8 hours from your dose before returning to breastfeeding. Observe your infant for flushing. If you have further questions, please call us at the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5 CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[shellyp22]

Okay, so basically one 5 mg vicodin/day should not harm my daughter especially if I don't feed her again till 7-8 hours later? One thing I forgot to ask, is what about fiorcet? I have that on hand also but seldomly take it cause I don't feel it helps. Is that compatible with breastfeeding? Thank you so much for your help

[cpride]

Dear shellyp22,

If you are having migraine headaches daily, Vicodin probably wouldn't be the drug of choice. If you need preventative migraine medication, there are several that are compatible with breastfeeding such as nortriptyline or nifedipine. Talk with your physician about preventive therapies available. Hydrocodone is a narcotic, and therefore, has the potential for addiction if taken daily. Butalbital compound (Fioricet) consists of three medications, acetaminophen, caffeine and butalbital. Fioricet has a long half-life of 40 to 140 hours so it would be in your system for an extended period but is probably compatible with breastfeeding. Observe your infant for sedation. It also should not be taken regularly since barbiturates also have the potential for addiction. Caffeine may cause irritability and insomnia in a breastfeeding infant if taken in moderate to large doses (greater than 1 cup of coffee daily). Hope this information is helpful.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[kerrichamberland]

i took fioricet one time and it knocked me out and kept my baby up ALL night and i was trying to nurse him while half asleep/ i probably shouldn't have done that, but the dr. kept telling me it was safe but the more i read about it, the more i think otherwise. i will probably not use fioricet again. i also tried nortryptiline and that made me feel like i had a really bad hangover and fog-brained and i STILL had the headaches. i have a 20 month old and a 3 month old and being groggy and sedated and having a migraine is not a good combo, i am not sure what the best thing is for me. i did take oxycodones when i was in the hospital for them and those worked if i took 2 of them but i know i cannot sustain that. the migraines have been getting less frequent but when they happen i am completely impaired and i was going to ask my ob if i could just take vicodin or percocets for the attacks instead of the sedating medications. is it bad for the baby> i would think that taking the pain medication as needed for migraine attacks is preferential bc the side effects of the others are debilitating. i don't have help with the kids and i am not sure what to do

[cpride]

Dear kerrichamberland,

You may want to talk with your physician about the use of sumatriptan succinate (Imitrex) for migraine headaches. The amount of sumatriptan that enters breastmilk is 3.5 % to 15.3 % of your dose. If you take the intramuscular injection, you should wait at least 4 hours from your dose to breastfeed. Once you are no longer feeling dizzy or having flushing then you may resume breastfeeding. If you take the pill form, waiting 8 hours is needed to allow 3 to 4 half-lives to pass before resuming breastfeeding. Observe your infant for flushing. If your physician recommends another medication, please call us at the InfantRisk Center, and we can give you further information. Our phone number is 806-352-2519. We are open 8 to 5 CDT, Monday through Friday.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[doublelatte]

Hello. I am from the Philippines, and I have been having migraine attacks for 2 straight weeks. These have been very debilitating for me. I was prescribed Sibelium (Flunarizine). I have seen three neurologists who prescribed different medications -- I begged them to take the pain away. I have taken Propanolol, Metrocloramide, Tramadol, Norgesic, Dexamethasone, Arcoxia for pain management.

My son is 2 years old and still nursing. I'm concerned about the effect of the medicine to my son, as I have read that this medicine is usually incompatible with breastfeeding. Please help.

[cpride]

Dear doublelatte,

Flunarizine has a very long half-life (time is takes for half of the drug to be eliminated from your system) of 19 days. Due to the long half-life and high volume of distribution, Dr. Hale states it is possible that this product, over time, could build up and concentrate in a breastfeeding child. You may talk with your physician about butalbital compound (Fioricet), ketorolac, nifedipine, nortriptyline, topiramate, sumatriptan, and nifedipine. These medications are compatible with breastfeeding and are used to treat migraine headaches. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[banana]

I would like to take 75mg topiramate, once daily, for chronic migraine, while nursing. My doctors are pretty skeptical about topiramate's compatibility with breastfeeding. Do you have any reassuring data that I could bring to them about its use? I would be thrilled if I could nurse even a little -- even once or twice a day would be fabulous. Is there an infant age where exposure to medications becomes less of a problem? (I could wait to take meds until the baby was a bit older.)

I know there is very little data on this. But any insight would be much appreciated. Thanks.

[Lifky]

I have a 12 day old nursing baby and took one fioricet (50 325,40) . I have pumped and dumped for 12 hours as I am worried about the butalbital. I see that it is not indicated for breastfeeding. How much longer should I wait until I continue breastfeeding. I am worried about the breathing or sedation as the pill made me feel "weird". Thanks so much.

[admin]

Lifky,

Fiorcet has a long half-life of 35 hours. When taken on occasion it is probably ok if you wait about 6 hours for a single dose, but since your infant is so young 12-24 hours maybe more suitable. This medication is not recommended for regular daily dosing as there are more suitable medications to use for migraines while nursing. Monitor your infant for sedation, slowed breathing rate/apnea, pallor, not waking to feed at regular intervals.


Sandra Lovato R.N.
InfantRisk Center
806-352-2519