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ADHD treatment during pregnancy and nursing

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  • ADHD treatment during pregnancy and nursing

    I am 31 and have ADHD and a 1 year old. I had previously been taking Adderall XR (25mg), and was told to stop taking this during my pregnancy and that there was no other safe alternative drug. Now I'm thinking about having another baby (I'm still nursing now so I haven't gone back on the Adderall yet), but I really want my medication back! Is there anything that is known to help ADHD that is safe to take during pregnancy? How about for nursing a 1 year old? I currently nurse 3x/day (first thing in the morning, around 5pm, and bedtime).

  • #2
    Dear LSmith,

    Medications used for ADHD include dextroamphetamine (Adderall), methylphenidate (Ritalin, Concerta, Focalin, etc) and lisdexamfetamine (Vyvanse). These all are category C for pregnancy. Pregnancy category C is defined as either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefit to the mother outweighs the potential risk to the fetus in this pregnancy category. Because animal studies have shown birth defects along with learning and memory deficits with dextroamphetamine, and there are no adequate human studies, this medication would not routinely be used during pregnancy. You should talk with your OB physician about the risk/benefits for your particular situation. Methylphenidate has a few human case reports of women who used the medication during pregnancy with no increased risk of birth defects. Because the numbers are small and the animal studies show birth defects, methylphenidate also should be discussed with your OB physician about the risks/benefits. Vyvanse is similar to Adderall in the above information.
    For breastfeeding, methylphenidate is the preferred medication because minute amounts are transferred into breastmilk. The time the medication would be highest in your breastmilk is two to three hours after you take your dose so avoid breastfeeding during that time. Observe your infant for agitation and poor weight gain. Dextroamphetamine and lisdexamfetamine have small amounts that transfer into breastmilk. The time they are highest is the first two to three hours after the dose, so try to avoid breastfeeding during that time. Again, observe your infant for agitation and poor weight gain. Doses of these medications should remain low during breastfeeding.

    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center