Lamotrigine and Adderall for ADHD

[Ilenef]

Mom is still pregnant and off these meds but wants to breastfeed and asked me if I could find out about these meds for her. Looking it up in Hale I see that neither of these is a great choice. Just wondering I didn't see anything in Clinical Therapy either for ADHD specifically. Are there medications you could suggest that would be better than the aforementioned? Thank you!

Ilene Fabisch, IBCLC/RLC

[cpride]

Dear Ilene,

Dextroamphetamine (Adderall) is compatible with breastfeeding in clinical doses. In the studies that have been done, none of the infants demonstrated untoward effects. This infant should be monitored for agitation and poor weight gain. An alternative medication that has a lower relative infant dose in breastmilk is methylphenidate (Ritalin or Concerta). Methylphenidate is preferred during breastfeeding as the relative infant dose is less than one percent of maternal dose but certainly dextroamphetamine may be used if doses are kept low. Lamotrigine may also be used during breastfeeding, but the infant should have plasma levels drawn to ensure safety. The relative infant dose varies from 9.2 percent to 18.3 percent of maternal dose. This infant should be monitored for sedation. There has been one report of apnea in a sixteen day old infant whose mother was on 850 mg daily of lamotrigine. The typical adult dose is 150 to 250 mg twice daily for seizures. Since this mother is using the medication for ADHD, she is probably on a lower dose. She may talk with her pediatrician about having infant's plasma levels drawn. Hope this information is helpful. Please call us at the InfantRisk Center if you have further questions. We are open Monday through Friday, 8 to 5, CDT. Our phone number is 806-352-2519.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center