Daily Xanax Use and Breastfeeding Continuation

[awestbr11]

As a long time sufferer of panic attacks and agoraphobia it was decided by my OB that I continue to take a 0.25mg dose of Xanax in the morning and evening every day. When medication was ceased during early pregnancy my blood pressure raised dramatically and episodes of syncope occurred. Baby was born healthy one week ago today. Breastfeeding is a concern for me, as I worry about the side effects of continuing to expose my baby to the medication. Exposure prenatally was already a huge concern, and exposure now is worrisome. I fear needless exposure now will do damage I was lucky enough to apparently avoid in utero. However, breast milk benefits cannot be denied, and I worry formula feeding would be more detrimental that breast milk feeding even while on the Xanax. My dose is still continuing at 0.25mg twice a day spaced approximately 12 hours apart. Should I continue to exclusively breastfeed while on the medication, or would it be safer to switch to formula only.

Much obliged,

A.L. Strika

[admin]

Ms. Strika:

I would agree with you that the risk of breastfeeding with Xanax is far far less than the risk of formula feeding. I would suggest you talk with you physician about some therapy with a product like Sertraline combined with Xanax or even better, lorazepam while you are breastfeeding. In general, the standard of care in treating panic and anxiety attacks is an SSRI.

But please remember, a healthy mom makes a healthy baby. Moms riddled with anxiety, depression, etc, are a risk factor for the good neurobehavioral development of infants. So make sure you take care of yourself, for your babies best development.

Tom Hale Ph.D.

[Babyblues]

Dr. Hale,
What are the risk factors to the baby if I take .25 or .5 of Xanax once per day? Would you advise stopping breastfeeding of my five month old, why or why not? Dr is also recommending Zoloft.
Thank you in advance!

[cpride]

Dear Babyblues,

The main risk for medications in the benzodiazepine family (Valium) is sedation and addiction. Dr. Hale recommends to use Xanax (alprazolam) short term, intermittently and low dose during breastfeeding. The dose you have stated appears low. The time the Xanax is highest in your milk is the first two hours after you take it so avoid that time to decrease the risk of sedation for your infant. If you need to take Xanax long term, wean the infant slowly to decrease the risk of withdrawal symptoms in your breastfeeding infant. Lorazepam (Ativan) is an alternative to Xanax that has a lower amount of medication that enters breastmilk. You may talk with your physician about it as an alternative to the Xanax. Only minimal amounts of Zoloft enters breastmilk. Observe your infant for sedation. Zoloft has a long half-life (time it takes for half of the drug to be eliminated from the body) so you may breastfeed as your infant needs. If you have further questions, call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center