Short-term Alprazolam use

[kcmiller]

Hello. I am currently exclusively breastfeeding my healthy 11 week old daughter. I have a history of panic attacks for which I took 50 mg of sertraline daily but weaned off as soon as I found out I was pregnant with no issues until recently when I started back to work. 4 days ago I started to feel waves of chest tightness and anxiety that has progressively gotten worse until last night when I had a full blown panic attack. Today I feel miserable and cannot function at work with the anxiety and waves of chest pain. I called my primary care physician and they could not get me in until tomorrow afternoon. I'm wondering if I could take one of the 1 mg Alprazolam tablets I have until I am able to start on sertraline again? If so, what dosage and frequency is considered safe while breastfeeding and is there a period of time I should wait after taking before breastfeeding or pumping again? Or would discontinuing breastfeeding and pumping/dumping and using formula be better short term? I have been trying to hold off but I'm paralyzed with fear.

Thank you.

[admin-james]

Hi, thanks for your post.

Alprazolam is one of the shorter acting benzodiazepines and is probably the best choice in that drug class for breastfeeding women. 1-2 mg per day is a level of exposure that is a good compromise between benefit to you and breastfeeding risk. There is no benefit to pumping and dumping with this medication. Try to use as little as you can while still getting good control of your anxiety. You will need to use the alprazolam until the sertraline starts working again, which could be 3-6 weeks. Watch your child for any difficulty waking up during feeding.

Sertraline is a well studied antidepressant in breastfeeding and found to be very safe. It is one of the few drugs that we have put in our "Safest" category (L1). Doses up to 150mg/day appear to have little to no effect on the breastfeeding infant. Long term, sertraline should be your drug of choice.

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

-James Abbey, MD
and
-Thomas W. Hale, Ph.D.