0.25mg alprazolam nightly use

[augustinr]

I have a five week old exclusively breastfed infant and am experiencing severe insomnia, which with my first baby precipitated a prolonged postpartum depression. In that case, the sleep deprivation caused the depression, rather than the insomnia being a symptom of depression – I simply couldn’t fall back asleep after waking to breastfeed my infant. I do not want to leave the insomnia untreated this time. I have found that 0.25mg of alprazolam administered once per night, every night, is effectively giving me the sleep I need. I have tried lorazepam since I understand it is the preferred benzodiazepine for use while breastfeeding and it unfortunately does not work. I have been able to express milk so that, after administering the 0.25mg of alprazolam immediately after breastfeeding, my husband can give a bottle at the next feeding, and my infant does not need to breastfeed again until six to seven hours after the medication was taken (so, there is a duration of at least six hours between my taking the 0.25mg and my infant getting breast milk from me). My question is twofold. First, does this regimen pose any risk to my infant if I continue it for about one month (after which we are hopeful he will be sleeping in longer stretches and I will no longer need the medication)? And, second, since the pka of alprazolam is 2.8 does that mean it will cycle fully out of my milk, or will it accumulate in my body and therefore my infant’s body?

[Sandra]

augustinr,

Xanax (alprazolam) is rated an L3-limited data-probably compatible. The amount that transfers is 8.5% of your dose. The dose you are taking is considered a low dose, but we do recommend waiting at least 2-3 hours to nurse after a dose since it is most concentrated in the milk in the first 2 hours. The half-life of this medication is 12-15 hours. Xanax has a low pKa so it is not likely to be trapped in the milk. Monitor your infant for sedation, slowed breathing rate, not waking to feed/poor feeding and weight gain. As long as you keep your dose low, and your infant is not symptomatic you could continue to breastfeed. If your infant becomes symptomatic wait longer to nurse and supplement some of the feedings.

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

[augustinr]

Are you aware of any long-term impacts on the health of a child at the dose I am taking and at the duration (0.25mg daily for one month), assuming his eating and weight gain continue to remain on track?

[augustinr]

Please see above (sorry for this second post, my computer was posting and error.)

[Sandra]

augustinr,

We are not aware of any long term effects as long as your infant is not symptomatic now.

Sandra Lovato R.N.