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Breastfeeding on all medications?

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  • Breastfeeding on all medications?

    Hi. I was on Percocet 10mg 4xday throughout pregnancy and have been breastfeeding. My concern is that after I had the baby, four weeks ago, my doctor started writing all my medications again. I have bad back problems, fibromyalgia and lupus, anxiety, etc. I stopped everything but the Percocet throughout pregnancy, but now my flares are so bad. I tried to wait as long as I could to start back taking everything so I could give him as long as I could breastfeeding, but I've been so sick and the pain is so bad. I feel awful. My question is, can I breastfeed on these medications? If so, which ones could I take and breast feed? I've been breastfeeding on the Percocet but I stopped breastfeeding day before yesterday because I had to take a robaxin 750mg and a xanax 0.5mg, and wasn't sure if he could have it. My doctor acted like it was ok, but I don't know. I'm on the Percocet 10mg 4x, and have started the Robaxin 750mg wrote for 3x and xanax 0.5mg 3x but I only took as needed. I was also prescribed neurontin 300mg for nerve pain but I haven't started that and another muscle relaxer zanaflex 4mg at bedtime that I haven't took. I really want to continue to breastfeed, I just don't know what to do. I can't go on not taking anything, but if I can get away with something and still breast feed, I'd be elated. What should I do?

  • #2
    Hi, thanks for your post.

    Let's start with the good news. Gabapentin is an older drug and better studied than most. Milk levels are generally low, infant levels are even lower, and no adverse events have been reported in the literature for children older than one month. There appears to be a substantial drop in side effect risk after the infant is older than one month. Gabapentin's dosage range is pretty broad and I would be comfortable with you breastfeeding on much higher doses.

    Alprazolam (Xanax) has limited human data about breastfeeding safety but so far no adverse effects have been reported in infants exposed to this drug. Of its drug class, Xanax is one of the better choices for breastfeeding mothers because it has a relatively short half-life. You should be fine taking this only as needed.

    The oxycodone in Percocet gets into breastmilk in fairly small amounts but can cause significant sedation in your baby. As long as he is arousable and feeding well you are probably OK. However, you are on the maximum safe dose of this medication, so keep a close eye on things. A much larger percentage of the acetaminophen (Tylenol) in Percocet gets into breastmilk. This drug is not harmful to babies as long as the dose is low. Both you and your baby should not take any other product containing acetaminophen without the expressed permission of a physician aware of your breastfeeding situation.

    Methocarbamol (Robaxin) is not well studied at all. Minimal amounts have been found in milk during animal studies. This medication can also cause sedation in your infant, so be careful when using this in combination with the other medications you are on. We have no safety information either way with this drug, so it's hard to say if it would be safe for your situation. If it were the only drug you were taking, I would be less concerned.

    Tizanidine (Zanaflex) is a possibly hazardous medication in breastfeeding mothers. Many of the pharmacological properties that make this a really good muscle relaxant also make it dangerous for a breastfeeding baby. If you are taking the conventional formulation (as opposed to sustained release) once or twice a week, you can avoid the danger by discarding your milk the following day. If you take it more often, or if you are on the sustained release ("SR","XR") version, that strategy will not work.

    In summary:
    1. Take Xanax and Zanaflex only when needed.
    2. Avoid taking more Tylenol or giving more to your baby.
    3. Watch your baby for sedation. This means that he should be waking up for regular feeding times and nursing well. If he appears overly drowsy or unable to feed several times in a row, there is a problem. You know your baby's normal patterns better than anyone. Continue to practice standard SIDS precautions.

    Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

    -James Abbey, MD