Migraine medications

[Sandra]

Aboeckel,

Topamax is rated an L3-limited data-probably compatible. The amount transferred into breast milk is relatively high any where from 24.65-55.65% of your dose, but plasma levels in 2 infants were only 10-20% of the moms plasma levels. [COLOR=#333333][FONT=lucida grande]Due to the fact that the plasma levels found in breastfeeding infants were significantly less than in maternal plasma, the risk of using this product in breastfeeding mothers is probably acceptable.[/FONT][/COLOR] The normal adult dose is 100-200mg twice a day so you are on a very low dose. It is probably ok to try and breastfeed as long as your infant is not symptomatic. Monitor for s[COLOR=#333333][FONT=lucida grande]edation or irritability, not waking to feed/poor feeding, diarrhea, elevated temperature and weight loss.

I hope this helps.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519[/FONT][/COLOR]

[Aboeckel]

My doctor recently prescribed topamax 25 mg at night for my constant/debilitating migraines. I had taken this medication before having children and this had worked best with keeping the migraines at bay. My 7 week old sleeps on average 6-7 hours at night. Is this safe for me to take while beastfeeding or is switching to formula safer for the baby. I would like to continue breastfeeding but I want to do what is safe for baby.

[admin-james]

Thanks for your question. Dr. Hale and I have discussed this one. The intranasal Imitrex seems to work faster and more effectively for people, although the chemistry is very similar to the pill. The amount of drug that makes it into the breastmilk is fairly small, but you can reduce this even further by waiting about 2-4 hours after your dose to breastfeed. At those very small levels, there have been no side effects reported in infants. Even though it's not perfectly safe, Imitrex is still the preferred drug in its class for breastfeeding.
Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

-James Abbey, MD

[migraineur]

I have been taking Maxalt for migraines (waiting several hours after a dose when possible to pump or pumping and dumping in the meantime) but am considering trying Imitrex again (it didn't work for me in the past) since it has been better studied with breastfeeding. I'm wondering about which kind to try - the intranasal or tablet. How would they compare in terms of the amount that gets into the milk and also the time needed to wait until pumping/nursing following a dose? Thanks.

[admin]

Dear Saki14,

Frovatriptan (Frova) is a typical tryptan believed to act on intracranial arteries to prevent excessive dilation of these vessels commonly found in migraine attacks. It is from the same family as sumatriptan. No data are available on its transfer into milk; however, its low protein binding and molecular weight suggest it may be found in breastmilk.

Tassneem Abdel Karim, MD
InfantRisk Center

[saki14]

Is there any data on the slow release triptans? specifically frova? i cannot take the short actings due to severe flushing. i am an exclusive pumper, pumping 4x/day. i am 9 months pp. thank you

[Mgmom]

Hi

I am using Zolmist nasal spray (active ingredient- Zolmitriptan) for my migraines which are twice or thrice a week. Part BF my 11 month old daughter (only at night). Is it ok to continue or is there a safer medicine

[admin]

Carolinem1981:

Below is what we know about Relpax. I think its probably safe to use, but you might want to wait 4-5 hours after using it to reduce the levels in milk. Also, another good choice for antihypertensive for your physician to evaluate is metoprolol. Its good for hypertension and good for migraines as well.

Tom Hale Ph.D.

=================

The manufacturer reports that in one study of 8 women given a single dose of 80 mg eletriptan, the mean total amount of eletriptan in breast milk over 24 hours in this group was approximately 0.02% of the administered dose.[1] The milk/plasma ratio was 0.25 but there was great variability. The resulting eletriptan concentration-time profile in milk was similar to that seen in the plasma over 24 hours, with very low concentrations of drug (mean 1.7 ng/mL) still present in the milk 18-24 hours post dose. It is not likely the clinical dose delivered above would harm a breastfed infant.

[Mgmom]

Hi I've been taking zolmist nasal spray twice a week for more than 6 months and my daughter is 11 months. Many times I pump and dump but lately since I only feed her at night and usually take the medicine before lunch, I don't pump. Is it ok to do this, are there any signs in my baby I should look out for?

[cpride]

Dear carolinem1981,

Eletriptan (Relpax) is a selective 5-hyroxytryptamine (5-HT) receptor agonist specifically used to treat migraine attacks. The manufacturer reports that 0.02% of the administered dose is present in milk. The time the drug is highest in your breastmilk is the first one and one-half hours after you take your dose so try to avoid breastfeeding during that time. It is not likely the clinical dose (typical dose 20 mg to 40 mg) would harm a breastfed infant. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[admin]

623 mommy:

we have no data on Zomig, but we have a really nice study on Imitrex. Investigate the intranasal Imitrex, works well and fast.

Tom Hale Ph.D.

[admin]

623mommy:

We have absolutely NO data on Zomig. But the data on Imitrex is quite good and suggests milk levels are very low. Investigate the intranasal Imitrex. Works well and very quickly.

Tom Hale Ph.D

[E&B'sMom]

Did you end up taking Relpax?

If so, did it have any effect on your baby? I too get debilitating migraines and started Relpax 40mg at onset years and years ago. I stopped using it once I got pregnant and throughout nursing my first. I now have my 2nd who is only 7 months and he's been more or less exclusively BF unless during one of the migraines I'm unable to nurse him for a while I supplement. I've had about 5-6 attacks and have gone without anything except taking Tylenol (which never helps). I never felt comfortable taking meds so I just waited them out but it's horrible, I get sick anywhere from 24-36 hours when I get them and am barely able to get out of bed. Most of the time I even vomit from them for at least a full day(sorry if TMI) I feel I'm At my wits end with them as I just struggled through one and I'm considering weaning my baby so I can take the Relpax which I know works but haven't come across and studies declaring its safe. Just wondering what your experience was with it.

[cpride]

Dear meliyet,

Dihydroergotamine mesylate (DHE 45) is an ergotamine drug used in the treatment of migraine headache and to enhance uterine contractions after delivery. We know that DHE 45 has high protein binding, and a large volume of distribution that would suggest only small amounts would enter into the milk compartment. The terminal half-life is 9 hours. DHE 45 is also poorly orally bioavailable so the infant would not be able to absorb much of the drug via breastmilk. Observe infant for hypertension. Since the infant is premature and may be on medications, possible untoward drug interactions are with CYP 3A4 inhibitors and macrolide antibiotics. Excessive dosing and prolonged administration may inhibit prolactin secretion and reduce mother's milk supply. Use during lactation is strongly discouraged. A similar medication called ergotamine is rated L 4 due to risk of decreasing prolactin, but only a minimal amount of the drug is absorbed by an adult. In summary, the risk to the infant would be low due to the kinetics of the drug, risk to the mother's milk supply especially if she had large doses and has been given multiple doses is high. Hope this information helps. If you have further questions, please call the InfantRisk Center at 806-352-2519.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[meliyet]

What do we know about dihydroergotamine DHE 45? My colleagues called me at home unable to find this in the 2010 book. I am working the NICU all wkend. Mom is 4 day post-op section. eclamptic delivered at 32 wks. Baby getting trophic feeds at this point. Appreciate an answer asap. thanks