Vyvanse

[Brinalyn]

My LO is five months-old. Before pregnancy, I was prescribed 50mg/daily of Vyvanse. I prefer to refrain from taking this medication daily while BFing, but I do take it ocassionally (probably four times in the past three months).

My protocol when I take it is as flows: I nurse the baby, pump, and then take my pill. I proceed to give the baby milk from my freezer stash for about 24 hours. In doing so, am I assuring that she gets a very minimal dose. Is waiting a full 24 hours necessary?

[admin-james]

Hi Brinalyn, thank you for your question.

There have been just a couple of clinical studies regarding Vyvanse and breastfeeding. They have shown that the infant gets about 1-2% of the mother's dose in the milk, assuming that she breastfeeds normally. There were no side effects reported in the infants that were exposed to that level of medication. However, those studies were small and may not apply to every baby. Here are a few things to consider:

1. If your ADHD is manageable by taking your meds only every few days, then your protocol is reasonable and very conservative. The half-life of Vyvanse is about 6 hours, so in 24 hours, it's basically gone. You can certainly maintain a freezer stash that covers that period of time. Based on the study that I mentioned above, it is my opinion that the full 24 hours is probably not necessary though. The study suggests that breastfeeding normally is safe. Discarding your milk for 6 or 12 hours (1-2 half-lives) is a reasonable compromise if you are still worried.

2. If you find that your ADHD is not well controlled, you should take your meds more frequently. Remember that your quality of life is important too! 50mg/day of Vyvanse is on the low end of the dosage spectrum for that drug. You can come up with a new routine that balances your milk supply with medication safety.

3. We give Vyvanse an L3 (out of 5) ("probably compatible") with regards to it's lactation safety, largely due to the limited data available. Other medications in the same family, such as methyfenidate (Concerta, Ritalin) and dexmethylfenidate (Focalin) are better studied and we give them an L2 ("probably safe"). If any of these medications work for you, they may be better options while you are breast feeding. Talk to your doctor about it. Side effects for all of these drugs, including Vyvanse, are agitation and poor weight gain in an infant.

Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519
-James Abbey, MD

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

Steiner E, Villen T, Hallberg M, Rane A. Amphetamine secretion in breast milk. Eur J Clin Pharmacol 1984; 27(1):123-124.
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.