Is Midazolam safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Midazolam. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
In a telephone follow-up study, 124 mothers who took a benzodiazepine while nursing reported whether their infants had any signs of sedation. Nineteen mothers took midazolam (presumably orally) while breastfeeding and none reported sedation in her infant.[ 10 ]
Effects on milk supply
Five women who were 6 to 15 weeks postpartum were given single doses of 2 mg of midazolam and 2.5 mg/kg of propofol intravenously before undergoing general anesthesia. The women's milk output following the surgical procedure was less than half of the normal milk output of nursing mothers. The authors speculated that milk volume might be reduced postoperatively because of perioperative fluid restriction and volume losses, as well as stress-induced inhibition of milk production.[ 6 ]
Levels in milk
Midazolam is about 36% bioavailable orally in adults. It is metabolized to 1-hydroxymidazolam (60 to 70%) and 4-hydroxymidazolam (5%) which are about equipotent to midazolam. The half-life of 1-hydroxymidazolam is about 12 hours in adults and can accumulate with prolonged or repeated doses or in renal impairment. Maternal Levels. Twelve mothers were given a total of 30 doses of oral midazolam 15 mg for sleep in the first 5 days postpartum if they requested it. In 11 of the mothers, midazolam was unmeasurable ( 3 mcg/L) in breastmilk 7 hours after the dose. One of the mothers accidentally took a second tablet (30 mg total) on one occasion and had a 7-hour milk level of 9 mcg/L. No accumulation occurred with repeated nightly doses in any of the mothers. Two additional women who were 2 to 3 months postpartum had hourly milk sampling after a single 15 mg dose. Peak milk levels of both the drug and metabolite occurred at 1 and 2 hours after the dose in the 2 patients. Peak milk levels of midazolam plus 1-hydroxymidazolam were about 13 mcg/L and the average milk level over the 7-hour period was 6.7 mcg/L.[ 7 ] Using these values, an infant exclusively nursing for 7 hours after a dose would receive about 0.3 mcg of the drug plus metabolite. A mother undergoing surgery received a single 6 mg dose of midazolam intravenously for anesthesia induction. Breastmilk concentration of midazolam was 25 mcg/L at 30 minutes after the dose, 12 mcg/L at 1 hour after the dose and 7 mcg/L at 2 hours after the dose. From 4 hours onward the drug was unmeasurable ( 5 mcg/L). Hydroxymidazolam was not measured.[ 8 ] Five women who were 6 to 15 weeks postpartum were given a single dose of 2 mg of midazolam intravenously before undergoing general anesthesia with propofol and fentanyl. Several milk samples were collected between 5 and 24 hours after the injection from each woman. The authors estimated that the infants would receive an average of 0.016 mcg/kg in the 24 hours after a single dose of
Alternatives LactMed lists
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.