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Lithium and a breastfeeding toddler

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  • redcanary
    started a topic Lithium and a breastfeeding toddler

    Lithium and a breastfeeding toddler

    Hello -

    I am nursing my 22 month old daughter. I have bipolar disorder and I've been hospitalized for a manic episode. I was previously taking 200mg of Lamictal a day, and now since hospitilization they have added Lithium. I am up to 1200mg a day, 600mg in the morning, 600mg in the evening. My serum level is currently .46 and hopefully rising as it is not yet at a therapeutic level for me.

    I am continuing to pump and collect milk, and I have been nursing my toddler when she visits. The doctors here are getting nervous about my continuing to breastfed while on Lithium. I haven't been able to find many studies about it, and the only ones I've found are about infants who were also exposed in utero. The doctors have asked me to think about weaning her, and I really don't want to have to do that as she is not ready yet. When I was home she still nursed several times a day.

    Can you give me any information about the safety breastfeeding a toddler while taking Lithium?
    Thanks in advance.

  • redcanary
    replied
    If you or anyone else are doing any current studies about Lithium in breastmilk, I would be more than happy to participate because I would like to be able to help other mothers feel safe while taking this drug while breastfeeding. Contact me if there are any such studies at this time.

    Thanks very much.

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  • admin-james
    replied
    Hi, thanks for your post.

    The safety of lithium during breastfeeding is somewhat controversial right now. Studies have repeatedly demonstrated that lithium ends up in the breastmilk in significant quantities. Specifically, lithium plasma levels in a breastfeeding infant vary widely and can range from 10-50% of the mother's plasma levels. It appears that the majority of the risk is in neonates and infants <3 months old due to their increased lithium sensitivity and decreased kidney function as compared to older children. No studies have been performed on children your daughter's age. Assuming that your daughter has a substantial diet in addition to breastmilk and that she shows no signs of lithium toxicity, we believe that continuing to breastfeed on lithium represents a low risk in your case. Once you have reached a therapeutic level, it would be prudent to measure your child's lithium level and kidney function, just to be sure everything is OK.

    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.

    The following references may be useful to your physician if he or she needs more information:

    Grandjean, E. M., & Aubry, J. M. (2009). Lithium: updated human knowledge using an evidence-based approach: part III: clinical safety. CNS Drugs, 23(5), 397-418.

    Llewellyn, A., Stowe, Z. N., & Strader, J. R., Jr. (1998). The use of lithium and management of women with bipolar disorder during pregnancy and lactation. J Clin Psychiatry, 59 Suppl 6, 57-64; discussion 65.

    Viguera, A. C., Newport, D. J., Ritchie, J., Stowe, Z., Whitfield, T., Mogielnicki, J., . . . Cohen, L. S. (2007). Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry, 164(2), 342-345.

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