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Clonazepam for panic and anxiety attacks- Newborn breastfeeding

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  • Clonazepam for panic and anxiety attacks- Newborn breastfeeding

    Hope you can help me. I took Celexa 40mg during my pregnancy to control anxiety and hopefully prevent PPA. My baby is almost one month old, breastfeeding is going well however my anxiety is getting very challenging to control and Psych NP wants me on Clonazepam 0.25 mg (schedule would be 0.25 mg upon waking up, 0.25 mg mid-day and 0.25 mg at bedtime). This way I hopefully can avoid terrible panic attacks. My OBGYN wants me to switch to formula because of this, however I heard of mom's breastfeeding on this medication but I do now have much information on how to set up my feedings. I currently feed on demand. All I know is that Clonazepam lasts 12 hours, however 0.25mg is such a small dosage, I'm wondering if there is a certain schedule that I need to follow with feeding OR if I really cannot breastfeed on it all and need to switch to formula? I asked about Xanax and Psych NP is really against and will not prescribe because I will be on it for a few months and Xanax is meant to be for short term usage only. Thank you so very much for helping me, this is just too way too much for me to figure it all out and breastfeeding is very important for us.

  • #2
    Hi, thanks for your post.

    These are both fairly safe drugs to use with breastfeeding. You are on typical low- to mid-range doses. The only downside to this regimen is that all of these drugs cause sedation in infants. Your baby will only be getting about 2-3% of your clonazepam through the breastmilk, but you should make sure he or she is able to wake up for feedings. If your baby has no signs of medication exposure, then you can consider this pair of meds to be safe for your situation; there are no long-term or "hidden" dangers that have been associated with these meds. Multiple studies have shown only minimal drug concentrations in the breastfeeding baby's blood.

    If you or your doctor continue to be concerned about the risks of these medications, then try working up to full breastfeeding. Start by alternating breastfeeding with hydrolyzed formula and watch your baby closely for changes in behavior and wakefulness. If you have no issues, resume full breastfeeding and spend another couple of days watching for changes. All the evidence that we have available to us suggests that you are unlikely to have problems.

    For anyone reading this, please post again or call us at the InfantRisk Center, (806)352-2519, if this has not completely answered your question. I would also appreciate you filling out a 2 minute survey about your time on the forum:

    https://tthsclubbock.co1.qualtrics.com/SE/?SID=SV_bJzhyKVSivVkQZL&Counselor=Web

    -James Abbey, MD

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    • #3
      Hello. I was diagnosed with anxiety disorder several years ago and was on Clonazepam for a number of years. It helped. I discontinued its use 3 months before becoming pregnant and have not taken it since. I had my baby three months ago. I am experiencing anxiety and would like to begin taking Clonzepam again. However, my doctor believes t is incompatible with breastfeeding. Here at the Infant Risk Center, I see that it is compatible in low doses. What do you advise I do? Speak to the doctor about the information found here? Or find a new doctor? I would not like to look like I am a "drug seeker" by asking for the medication.

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      • #4
        eowyn12, thanks for posting,

        Clonazepam enters minimally into breast milk with only 2.8% of your dose transferring. It is most concentrated in the breast milk at 1-4 hours, and has a half life of 18-50 hours. We recommend keeping your dose low, and to monitor the infant for sedation, slowed breathing rate, not waking to feed/poor feeding and weight gain. We recommend having your Dr look at our website infantrisk.com, or the Dr is welcome to call the InfantRisk Center and we can give him our data, or he can find the data in Dr Hale's book "Medications and Mothers' Milk". If you are unable to get medications from your Dr to treat your anxiety you may wish to switch Dr's but that is your decision. I hope this helps, if you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks,

        Sandra Lovato R.N.
        InfantRisk Center

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