Clonazepam and weaning a child from breastfeeding.

[Cab83]

Hello,

I was prescribed clonazepam due to debilitating anxiety when my son was just shy of 2 years old. I was breastfeeding him at the time this medication was prescribed and he is still breastfeeding today (3x daily). I began this medication last March by taking .5 to 1mg daily for a few months, but decreased down to .5mg daily for the most part and am currently in the process of weaning myself even more so I can be off of it completely at some point. I’m taking .25 to .5mg daily and hope to be down to a consistent dose of .25mg daily in the next month or so. I have been having horrible guilt that I ever took it to begin with and have gone down the “Google Rabbit Hole” and feel horrified that this medication may have built up in my toddlers system. He will be 3 in a couple of weeks. He’s never had any side effects from it from what I could tell. My question is this: I am hoping to wean him from breastfeeding soon, but I don’t want to put him at risk of any sort of withdrawal symptoms from the medication since he has been getting 2 to 3% of my dosage for a year. How can I safely go about this process. I think weaning him would do wonders for my mental health, but I also want to go about this as safely as possible for him.

Thank you for your time.

[nicholec]

Good morning,

First of all, I applaud you for continuing to breastfeed while recognizing and treating your own mental health needs at the same time. Many women neglect themselves out of fear for their baby's health and it is not always necessary.

I want to reassure you that since your son is now 3 years old, he is not getting much milk, and has likely had very minimal drug exposure. As you have titrated down on your medication, he naturally has as well in addition to decreased milk consumption as he has aged. The lack of side effects on his end is reassuring.

The relative infant dosage (RID) of clonazepam that we use is 2.8%. This does NOT mean that he is getting 2.8% of your dosage. This calculation means that he is only getting 2.8% of a toddler sized dose. In this case, given the amount of milk he has been receiving and your low dosages, I would argue that the amount he has been exposed to is minimal if present at all. Had you used it in infancy when he depended on you for milk as his main nutrition source, it would be a little bit different.

In a group of 11 mothers receiving 0.25 to 2 mg clonazepam daily, 10 of 11 breastfed infants had no detectable (limit of detection: 5-14 µg/L) clonazepam or metabolites in their serum. One infant (1.9-weeks-old) had a serum concentration of 22 µg/L. Maternal dose was 0.5 mg daily.

You're doing a great job, mama. Feel free to wean when you are ready without fear of harming your son.

Nichole Campbell, MSN, APRN-NP-C

[Cab83]

I really appreciate your reply. Thank you for putting my mind at ease. He has been a very picky eater since the introduction of solid foods at 6 months old, so he relied on nutrition from me more than an average infant/toddler. But yes, it is good (in some ways) that I didn’t start taking this medication when he was an infant. He didn’t begin sleeping through the night until this past December (at that point nursing decreased from about 5 to 3 sessions a day). So I think he was nursing more when I was on a higher dosage (.5 to 1mg). I just wanted to clarify that a bit, in case that makes any difference. I don’t think it will change much of what you said in your initial reply, but let me know if it does. I’ll continue to decrease my dose in the next month and most likely wean him after that.

Thank you again.