Vyvanse and a 6 month old???

[NatalieR]

I just recently started taking my ADHD meds again (after pregnancy).

My son will be 6 months old in just a few days and due to starting the medication 3 days ago I have begun to wean him during the day.

I take 40 mg of Vyvanse at 6 in the morning and I nurse him right after I take it - I mean swallow the pill and then immediately sit down to nurse before there is any in my milk.

During the day I give him bottles (formula) and just started him on rice cereal.

I nurse him again at 2pm right before I take the end of the day dose of 20 mg of Vyvanse.

I nurse him often in the middle of the night 3-4 times or so - sometimes less it just depends on when he wakes up.

I have tried the other meds for ADHD in the past and this has been the best one so far to control my symptoms the methyphenidate ones seemed to do nothing of significance but this med is like night and day difference for me.

My doctor was not thrilled that I chose to continue nursing my son and even made me sign a medical release that if something happened he wouldn't be held responsible and warned me of possible sudden death if any of the meds were to get into the milk??? I've never heard of that before. Have babies died of SIDS or cardiac problems when they had mothers who were on stimulants and nursing them?

From what I read here I didn't think the doses I was taking and the amount my son would be getting would be that significant but after reading an article in the news about a woman who accidentally killed her baby by breastfeeding and taking morphine it scares me that if something ever did happen to my baby that the legal ramifications would be harsh. Not to mention my own doctor's ominous warning (despite his own admission that he has never dealt with this issue personally) has scared the heck out of me and I'm thinking of weaning him altogether!

I want to do the right thing by nursing my baby but NOT if it is going to put him in danger. I guess I am just looking for guidance as to what the right thing is to do here??

[admin]

Dear NatalieR,

Lisdexamfetamine (Vyvanse) is a prodrug and is rapidly metabolized to dextroamphetamine. Dextroamphetamine apparently transfers into milk avidly. Of the 6 infants studied thus far, no untoward effects have been reported in any infant. If this product is used in breastfeeding mothers, the dose should be kept low, and infants should be monitored for agitation, and poor weight gain. Methylphenidate is probably preferred. With normal therapeutic doses, the dose of dextroamphetamine in milk is probably subclinical. However, abusive use of this medication is common. Thus mothers should be strongly advised to withhold breastfeeding for 24 hours following the non-clinical use of dextroamphetamine.

This medication is rated by Dr. Hale as an L3 (Probably safe) during breastfeeding. The time when the medication is highest in your system is for 3.5 hours after you take it. The best way to do this is to breastfeed the baby first, and then immediately take the medication AFTER your done with the feeding. If you can, withhold from breastfeeding for about 3.5 hours to ensure least amount of transfer. Furthermore, this medication has a Relative Infant Dose of 1-6% of what you take, this is a small RID.

Here are some refernces for you to give to your physician:
1- Steiner E, Villen T, Hallberg M, Rane A. Amphetamine secretion in breast milk. Eur J Clin Pharmacol 1984; 27(1):123-124.
2- Ilett KF, Hackett LP, Kristensen JH, Kohan R. Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. Br J Clin Pharmacol 2006; 63(3): 371-375.


Hope this helps!!! Call me at the InfantRisk Center on 806-352-2519 if you have anymore questions.

Tassneem Abdel Karim, MD
InfantRisk Center