Severe anxiety

[ButterCup]

Hello, I'm still breastfeeding my 16 months old, I might have to get onto something for anxiety, I wish to know which would be safer for her, Zoloft or Ativan?, or are there other options for anxiety? Thank you very much.

[ButterCup]

I have to add that she still nurses a lot? Thanks!

[Sandra]

Buttercup, thanks for posting,

Zoloft (sertraline) is rated L1-extensive data-compatible. The amount transferred into breast milk is 0.4-2.2% of your dose. Sertraline has been extensively studied in many breastfeeding mothers. The data is consistent that levels in milk are quite low and do not normally affect an infant. Studies of platelet function further suggest that sertraline is poorly absorbed by the infant and at levels too low to affect platelet function. Sertraline is a preferred antidepressant. Monitor the infant for sedation or irritability, not waking to feed/poor feeding and weight gain.

Ativan (lorazepam) is rated L3- limited data-probably compatible. The amount transferred into breast milk is 2.6-2.9% of your dose. The benzodiazepine family, as a rule, is not ideal for breastfeeding mothers due to relatively long half-lives and the development of dependence. However, it is apparent that the shorter-acting benzodiazepines are safer during lactation provided their use is short-term or intermittent, low dose, and after the first week of life. Lorazepam transfer into human milk is minimal, and it is the better choice for use in breastfeeding since it has a shorter half-life and is not as addicting as other benzodiazapines such as xanax, Klonopin and valium. Monitor for Sedation, slowed breathing rate, not waking to feed/poor feeding and weight gain.

For long term use to help treat your anxiety zoloft would be preferred, but the use of ativan for acute anxiety would also be ok as long as the infant is not symptomatic. 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

[ButterCup]

Thank you Samdra, I went today and the psychiatrist prescribe Alprazolam, I read it's a short live benzodiazepine?, he said we were going to use a ver low dose, 0.25 every six hours, to keep it low in blood but constant, any advice on this med? I suggested the Ativan but he said he preferred this one, and that we will change soon to the Zoloft because he doesn't want to creat dependence on me, I think we will use it a couple of weeks? He only prescribed for two weeks. I would really appreciate your input.

[Sandra]

Buttercup,

Alprazolam (xanax) is rated L3-limited data-probably compatible. The amount transferred to milk is 8.5% of your dose. The half-life is 12-15 hours. Alprazolam is probably safe to use during breastfeeding when used short-term, intermittently, and low dose after the first week of life. Monitor the infant for sedation, slowed breathing rate, not waking to feed/poor feeding and weight gain. I might suggest if he is going to place you on zoloft to begin it now because it will take about 2-3 weeks for this medication to work in you. Thanks,

Sandra Lovato R.N.
InfantRisk Center

[ButterCup]

Sandra, she is 16 months old, does that makes a different?, I find 8.5% a lot, ugh, and i just want to feel breastfeeding is safe for my toddler, maybe I should push for Ativan?, my baby is 24.25 pounds. And is 15 days consider a short amount of time?

[Sandra]

Buttercup,

Yes it does make a difference that your infant is 16 months old. Older infants will get less breast milk per their body weight than say a newborn or younger infant would, and they are better able to metabolize and excrete medications as they get older. Fifteen days would be considered short term. We consider with a lot of medications that 10% and below are relatively safe in breastfeeding. It is probably ok to breastfeed and take this medication as long as the infant is not symptomatic.

Sandra Lovato R.N.
InfantRisk Center

[ButterCup]

Thank you so much, I really appreciate what you are doing here for lots of mothers.

[ButterCup]

Medication changed

Hello! My Doctor changed my medication to Lorazepam 1mg twice a day, I just want to know if this dose is ok with breastfeeding my 17 month old baby girl and how high of a dose of lorazepam is safe while breastfeeding.

[Sandra]

Buttercup, thanks for posting,

Ativan (lorazepam) is rated L3-limited data-probably compatible. The amount transferred into breast milk is 2.6-2.9% of your dose. Your child is older and will probably tolerate this medicine ok. Monitor her for sedation, slowed breathing rate, not waking to feed/poor feeding and weight gain. As long as your little girl is not symptomatic it should be ok. Be sure when you decide to stop breastfeeding to wean her slowly so that she does not have any withdrawal symptoms.

I hope this helps. If you have ant other questions please call the InfantRisk Center at 806-352-2519. Thanks,

Sandra Lovato R.N.
InfantRisk Center

[ButterCup]

Is it recommended to wean?

My Doctor changed alprazolam to lorazepam on my request and of course with his approval because all that I read says is safer than alprazolam?, but are the side effects and widrawl symptoms for the baby the same? What is consider short term use? Are there other anxiolytics safer and not from the benzodiazepines group!, and how much Lorazepan is consider a high dose?, thank you Sandra.

[Sandra]

ButterCup,

The side effects and withdrawal symptoms will be the same for lorazepam as they are for alprazolam. Short term is usually considered a month or less, but you can use longer if you need them as long as the infant is not symptomatic. Buspar (buspirone) is a anxiolytic that is not a benzodiazepine. It is rated an L3-no data-probably compatible. Currently there are no data regarding buspirone excretion into human milk however several properties of this medication suggest it has difficulty-entering breast milk such as high protein binding, short half-life, large volume of distribution, low oral bioavailability, and minimally active metabolites. It has a short half-life of only 2-3 hours so you could work around the time easily. This medication needs to be taken on a regular basis, it will not relieve anxiety quickly like a benzodiazepine will for an acute anxiety attack, but when taken regularly is a good alternative. Monitor the infant for behavioral changes, feeding problems, and appropriate weight gain. Thanks,

Sandra Lovato R.N.
InfantRisk Center
806-352-2519