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  • Conflicting information

    I am looking for some reassurance and clarification. My baby was born 6/25/19 and was admitted to the NICU twice - immediately post birth for low blood sugar and a week later for what they think was meningitis. The latter event was extremely traumatic for me.
    I have two questions — one about clonazepam and one about Wellbutrin. My perinatal psychiatrist (I see her twice a year because she is located out of state) prescribed 1 mg of clonazepam during pregnancy, but advised me against taking it while breastfeeding because she says it “builds up” in the baby’s system due to the long half life. My local psychiatrist and pediatrician both want me to take the clonazepam because they think the benefits of breast milk outweigh any adverse effects of the clonazepam.
    1. Could someone explain to me the ramifications of the clonazepam building up in my baby’s system? And will he go through withdrawals if I decide to stop taking it?
    2. I was prescribed 150 mg of Wellbutrin on 8/13 and in the past few days, my baby has seemed much more irritable. I’m not sure “jittery” is accurate. He just seems a lot more agitated. How can I determine if the catalyst for this is Wellbutrin? Should I simply stop taking the Wellbutrin so I can breastfeed?
    I sincerely appreciate your guidance.

  • #2

    This all we know about clonazepam.

    Tom Hale

    Clonazepam is a benzodiazepine anxiolytic and anticonvulsant. In one case report, milk levels varied between 11 and 13 µg/L (the maternal dose was omitted).[1] Milk/maternal serum ratio was approximately 0.33. In this report, the infant's serum level of clonazepam dropped from 4.4 µg/L at birth to 1 µg/L at 14 days while continuing to breastfeed, suggesting increasing clearance with time. In this case, excessive periodic breathing and apnea and cyanosis occurred in this infant (36 weeks gestation) at 6 hours until 10 days postpartum. The infant was exposed in utero as well as postpartum via breastmilk.

    In another study of a mother treated with 2 mg clonazepam twice daily recorded peak milk concentrations of 10.7 µg/L at 4 hours post dose, and a maximum infant dose of 2.5% of the weight-adjusted maternal dose. The infant's serum level of clonazepam at days 2-4 was 4.7 µg/L.[2]

    In a group of 11 mothers receiving 0.25 to 2 mg clonazepam daily, 10 of 11 breastfed infants had no detectable (limit of detection: 5-14 µg/L) clonazepam or metabolites in their serum.[3] One infant (1.9 weeks old) had a serum concentration of 22 µg/L. Maternal dose was 0.5 mg daily.

    In another study that included 124 breastfeeding women and their infants (aged 2-24 months), 2 infants (1.6%) were reported as having CNS depression.[4] The three most commonly taken benzodiazepines were lorazepam (52%), clonazepam (18%) and midazolam (15%). There was no correlation between infant sedation and maternal benzodiazepine dose or duration of use. The two mothers who reported infants with sedation were taking more medications that also cause similar CNS adverse effects than those without infant concerns (mean of 3.5 versus 1.7 medications).

    These data suggest a low incidence of toxicity with this medication in breastfeeding infants.


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