ADHD medication and Breastfed 11 month old

[concernedmom]

I stopped taking Adderall when I found out I was pregnant. My daughter is now almost a year old - still mostly breastfed but expanding her appetite. I have held out for a long time but I feel like my life is crumbling all around me not being on my medication. My relationship is suffering, i can never get anything done at home, I have a million projects open and none completed, the house is a disaster... not to mention my work is suffering tremendously. I need to go back on my medication - i am just not sure what is safest. I havent taken medication in so long I feel like I would start at 5 or 10 mg 2x day - I just know adderall is what was effective in the past I dont know if I should try ritalin which i have researched and found to be safer for breastfed babies. I also wonder if at such a low dose since I pump while I am at work so I wonder if I could pump right before I took the medication and wait 3-4 hours to pump again and then take a second dose - if that would lessen the amount my baby gets (or how to better time all that). My other question is if I freeze the milk I pump while on medication will it still be active if i give it to my baby 3-4 months down the line? I have plenty of frozen milk that i could start giving her and freeze what I get while on medication if that would make the medication not transfer to her as much. I still would want to breastfeed her when I get home from work and she eats A LOT at night when going to sleep and througout the night but I think it would be out of my system mostly by that time.

Please help
! Advice needed! I dont knwo what to do!

[admin]

Dear Concernedmom,

Adderall (dextroamphetamine) is a potent, long-acting amphetamine. We know that approximately 1.8 to 6.9 percent of your dose enters breastmilk. The time Adderall would be most concentrated in your breastmilk would be one to two hours after your dose so it is usually best to breastfeed first then take your dose then wait two to three hours to resume breastfeeding. Monitor your infant for agitation and poor weight gain. As long as the dose is kept low, Adderall appears to be compatible with breastfeeding.

Methylphenidate (Ritalin) is a safer alternative, that transfers into breastmilk in lower amounts. Only 0.2 to 0.4 percent of your dose would enter the milk compartment. The typical dose is 10 mg two to three times per day. The time the drug is most concentrated is one to three hours after the dose so avoid feeding during that time. Observe infant for insomnia and nervousness.

Let me know if you have further questions.

Sandra Lovato R.N,
InfantRisk Center

[MidwifeMomma]

I am also curious as to this part of her question - "My other question is if I freeze the milk I pump while on medication will it still be active if i give it to my baby 3-4 months down the line?" Thanks!

[admin]

MidwifeMomma:

Absolutely, the drug will still be present in the milk, months later.

I do not recommend using old frozen drug-containing milk at a later date. Basically, IF you don't have to expose an infant to a drug (such as in this case), please don't. It's not worth the risk. What if the infant had an allergic response, or apnea, or some other unique complication to a drug in old milk.

In cases where moms have no other milk, available, such as early postnatally, then go ahead and breastfeed. But the above is 'optional' and it's not mandatory to use old stored milk.

Tom Hale Ph.D.