Seroquel and lamictal, GABA and newborn

[Betsy]

My client is bipolar and has anxiety disorder. She is on low doses of these three medications and is three days postpartum. Currently, she feels stable. Her psychiatrist told her it was safe to breastfeed and she asked me to confirm. Although her milk has transitioned from colostrum to more mature milk, the volume isn't in and she hasn't had appearance of lactogenesis II. Are these meds implicated in low milk supply in any way?

[admin]

Betsy,

Lamictal and Seroquel are probably ok, the infant is exposed to more in utero than breast milk.

The GABA is not in our data base, it is found in the Natural Standard data base and for an adult has been used safely up to 12 weeks. Recommended dose is 750mg a day. High doses of 10gm has been associated with wheezing, rapid heart rate, flushing and anxiety. Safety of long term use has not been established. In breastfeeding there is insufficient reliable information regarding the safety so we cannot recommend the use of this product. This product can interfere with antihypertensive medications, and any herbs that could potentially lower blood pressure.


Seroquel is rated an L2-probably compatible. The amount transferred into breast milk is 0.02-0.1% of moms dose. Monitor the infant for sedation or irritability, apnea, not waking to feed/poor feeding, extrapyramidal symptoms and weight gain.

Lamictal is rated an L2-probably compatible. The amount transferred into breast milk is 9.2-18.27% of moms dose. Monitor the infant for sedation or irritability, not waking to feed/poor feeding, weight gain and rash. Based on clinical symptoms some infants may require monitoring of liver enzymes or CBC. Breast milk levels are relatively high, reported infant plasma levels are 15- 30% of maternal levels. We recommend checking the infants plasma levels 2-3 weeks postpartum to see if they are within normal limits.

As for milk supply the Seroquel has been linked with an increase in prolactin levels, no reports of decreased milk supply with Lamictal to our knowledge, and no data on the GABA.


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

[Betsy]

Thank you Sandra, I appreciate it. Mom's milk supply is still low approx 2 weeks pp. Are any galactogogues compatible with these medications, specificically: moringa/malunggay, shatavari, goat's rue, or possibly domperidone? Thank you.

[admin]

Betsy,

There is a drug to drug interaction with Seroquel and Domperidone, concurrent use may increase the risk of of QT interval prolongation. As for the herbal meds we do not have enough information to say about drug interactions.

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