Is Neostigmine safe while breastfeeding?

Effects on the breastfed infant

Six infants of mothers treated with neostigmine for myasthenia gravis were reportedly breastfed successfully. One newborn infant appeared to have abdominal cramps after each breastfeeding, probably caused by neostigmine, although it could not be detected in the breastmilk of the infant's mother.[ 1 ]

Effects on milk supply

Relevant published information in nursing mothers was not found as of the revision date. In animals, cholinergic drugs increase oxytocin release,[ 2 ] and have variable effects on serum prolactin.[ 3 ] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. A study compared neostigmine to sugammadex in their effects on lactation-related hormones in women undergoing cesarean section surgery under general anesthesia. Both groups showed significant decreases in progesterone and estradiol levels after surgery compared to preoperative values; however, the sugammadex group exhibited a significantly greater decrease. Aldosterone levels reached their highest point at the end of surgery, but by 4 hours later they were lower than before surgery, especially in the sugammadex group. Cortisol showed a temporary postoperative elevation, whereas prolactin and oxytocin levels rose in both groups, with no significant intergroup variations.[ 4 ]

Levels in milk

Maternal Levels. In a case series of 12 patients with 21 pregnancies in the 1950s and 1960s, the authors could not detect neostigmine in the breastmilk of several of the mothers. However, details of the dosage, timing and assay sensitivity were not stated.[ 1 ] Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Pyridostigmine