Amitriptyine/baclofen/gabapentin/lidocaine cream for vulvodynia

[ak02]

A physician prescribed this compounded cream for me to use topically (daily) for pelvic pain/vulvodynia. I am breastfeeding an 8-month-old and the physician suggested that this is fine, but I was hoping for independent confirmation. I don't know that there is research about absorption of these drugs taken topically...?

He also prescribed estrogen cream for dryness which from what I've seen doesn't seem to be too much of an issue (though potential for decreasing supply?).

[cpride]

Dear ak02,

In most cases, topical creams don't get absorbed into the blood system well; therefore, don't get into breastmilk in clinically relevant amounts.

Becuse we or the pharmacist won't really know much about the systemic absorption of these drugs vaginally, Dr. Hale suggests some caution in using it while breastfeeding. Its not likely to cause many problems, but we simply can't advise you that it is safe. If absorption occurs, your infant should be observed for sedation, dilated pupils, and dry mouth. The main risk with the other medications is sedation.

As for the estrogen product, it may indeed be absorbed systemically to some degree. We think, although we do not know for sure, that estrogens may suppress the milk supply in some women. So we are really cautious about using any form of estrogen while breastfeeding. Its not that estrogen gets into milk, it doesn't much, its that it could suppress your milk supply.

If you have further questions, call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center