maxalt and nursing a 6 week old infant

[midwifemichelle]

I have a patient with a h/o atypical migraines (comes with neurological sequelae such as facial drooping, numbness/tingling in extremities, etc). She is 7 wks s/p c/s and is nursing exclusively. Was on Maxalt prior to pregnancy, but she chose to stop for duration of pregnancy. Now that she is postpartum, headaches are worsening and she'd like to return to maxalt. Do you have any info on its safety in lactation? Thank you.

[cpride]

Dear midwifemichelle,

Rizatriptan (Maxalt) is a selective serotonin receptor agonist, similar in effect to sumatriptan. No data are available on its transfer into human milk, but it is concentrated in rodent milk. Until we have clear data on breastmilk levels, the kinetics of this drug may predispose to higher milk levels, and sumatriptan (Imitrex) should be preferred. If this mother does decide to use this medication, it is recommended for her to wait 4 hours after the dose before resuming breastfeeding. Observe infant for sedation and dry mouth.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[midwifemichelle]

Thank you so much for your rapid response. We think she will continue with Maxalt (as it is known to work with her when she has failed other migraine meds). However, once I read her this response, her first question was, "Can I donate my pump&dump milk to you (the Infant Risk Center), to study the Maxalt levels?" She would like to contribute to the knowledge base of this medication. You may contact me offline, if necessary. Thank you!

[cpride]

Dear midwifemichelle,

Please let your client know how much we appreciate her willingness to donate breastmilk to further our understanding of medications used during lactation. Dr. Hale is involved in several clinical trials so is unable to undertake a clinical trial for rizatriptan (Maxalt) at this time.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Aniven]

Is there any new data on maxalt and breastfeeding? If not can I start breastfeeding again after four hours or so I need to pump and dump after four hours?

[Sandra]

Aniven,

At this time there is no available data on the transfer of Maxalt into breast milk. The half-life is 2-3 hours. If you are only using this medication on occasion and wait 4 hours it is probably ok as long as your infant is not symptomatic. Monitor your infant for drowsiness, vomiting, poor feeding. Imitrex is the preferred triptan.

Sandra Lovato R.N.
InfantRisk Center