Ritalin and breastfeeding

[Girseach]

Has any research been done on occasional Ritalin use (20mg, non SR) while breastfeeding? I was diagnosed w ADHD at 21, had been on Ritalin since that time- 20 mg, TID. I stopped when I became pregnant in my late 30's. I want to breastfeed, but am concerned once I return to work that for certain events ( for example, a presentation and Q&A session) that it will be difficult to go without meds. Is there any way to determine the metabolisation rate of Ritalin in breast milk? If one dose were taken - would a bf'ing mother need to pump and dump, or is there a minimum time interval before her milk would be safe for her infant to ingest?
Thank you in advance!

[admin]

Girseach:

We have only limited data on methylphenidate. Study two below was one I did, and levels in milk were really quite low. It appears to enter milk poorly.

Tom Hale Ph.D.


From InfantRisk Database --------------------

The pharmacologic effects of methylphenidate are similar to those of amphetamines and includes CNS stimulation.[1] It is presently used for narcolepsy and attention deficit hyperactivity syndrome. In a study of 3 women receiving an average of 52 (35-80) mg/day of methylphenidate, the average drug in milk was 19 (13-28) ?g/L.[2] The milk/plasma ratio averaged 2.8 (2-3.6). The absolute infant dose averaged 2.9 (2-4.25) ?g/kg/day. The average relative infant dose was 0.9% (0.7-1.1).

In the one infant studied, plasma levels were <1 ?g/L. These levels are probably too low to clinically relevant. Another case reported a mother taking 15 mg/day with breast milk concentrations averaging 2.5 ng/mL. The daily infant dose was estimated at 0.38 ?g/kg, which corresponds to 0.16% of the maternal dose.[3] No drug was detected in breast milk 20-21 hours after the maternal dose. A mother taking 80 mg/day was determined to have a milk-to-plasma ratio of 2.7, giving an absolute infant dose of 2.3 ?g/kg/day, or 0.2% of the maternal dose. Methylphenidate was not detected in the infant's plasma.[4] No adverse effects were noted in any of the infants. These levels are significantly less than for dextroamphetamine. Infants should be observed for agitation, and reduced weight gain although these are quite unlikely at these levels.