Is Oxybate Salts safe while breastfeeding?

Effects on the breastfed infant

A woman was taking 4.5 grams of sodium oxybate twice daily (exact times not reported) for narcolepsy and cataplexy throughout pregnancy and lactation. She breastfed her infant (extent and times not stated). No adverse infant effects were reported.[ 2 ] A woman with narcolepsy took sodium oxybate 4 grams each night at 10 pm and 2 am as well as fluoxetine 20 mg and cetirizine 5 mg daily throughout pregnancy and postpartum. She breastfed her infant except for 4 hours after the 10 pm oxybate dose and 4 hours after the 2 am dose. She either pumped breastmilk or breastfed her infant just before each dose of oxybate. The infant was exclusively breastfed, or breastmilk fed for 6 months when solids were introduced. The infant was evaluated at 2, 4 and 6 months with the Ages and Stages Questionnaires, which were withing the normal range as were the infant's growth and pediatrician's clinical impressions regarding the infant's growth and development.[ 5 ] An abstract reported a woman with narcolepsy who resumed taking sodium oxybate 6 grams at bedtime at 12 weeks postpartum. The mother reportedly used a structured pump-and-feed schedule. The infant demonstrated normal growth and development through three years of follow-up.[ 6 ]

Effects on milk supply

Relevant published information was not found as of the revision date.

Levels in milk

Maternal Levels. Blood and breastmilk samples were collected from 20 nursing mothers twice between the second week and fourth month postpartum. Endogenous breastmilk levels averaged 0.35 and 0.36 mg/L at the two time points. The authors proposed establishment of a normal GHB breastmilk reference range of 0.13 to 1.03 mg/L.[ 2 ] A woman with narcolepsy with cataplexy took a single dose of sodium oxybate 4.5 grams. Breastmilk samples were obtained separately from the right and left breasts at 7 and 9 weeks postpartum. Milk concentrations from the right breast at week 9 postpartum had a peak value of 23.2 mg/L at 1 hour after the dose, decreasing to 3.1 mg/L at 4 hours after the dose and 1 mg/L at 5 hours after the dose, at which time the concentration was within the proposed endogenous breastmilk reference range of 0.13 to 1.03 mg/L. No differences were found between left and right breast or between week 7 and 9 samples.[ 2 ] A paper reported two mothers with narcolepsy and cataplexy who collected breastmilk samples during therapeutic use of sodium oxybate. Neither breastfed her infant during this time. One mother who was 5 months postpartum took 3 grams of sodium oxybate twice a night for one night and 4.5 grams twice a night for a second night. Pre-dose breastmilk levels were 0.66 and 0.6 mg/L (6.3 and 5.8 micromoles/L) on the two nights, which represent normal endogenous milk levels. At 4 hours after the first 3 gram dose, the breastmilk level was 1.09 mg/L (10.44 micromoles/L); the milk level at 3 to 4 hours after the second dose was 1.7 mg/L (16.5 micromoles/L). Four hours after the first 4.5 gram dose, the breastmilk level was 2.5 mg/L (23.58 micromoles/L); the milk level at 3 to 4 hours after the second dose was 2.9 mg/L (27.5 micromoles/L). Breastmilk levels had returned to normal physiological levels by 6 to 7 hours after the second doses. The second mother collected milk samples after two pregnancies. Because of inconsistent results and a lack of baseline va

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