Is Pregabalin safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Pregabalin. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
A nursing mother with Raynaud s phenomenon of the nipple was taking nifedipine, which resolved the nipple blanching, but not the lancing pain in the breast that occurred several times daily. Pregabalin 75 mg twice daily was added which almost completely resolved the pain. Her infant was exclusively breastfed for 3 months and experienced no adverse effects.[ 5 ]
Effects on milk supply
A study randomized pregnant women to either a single dose of pregabalin 150 mg (n = 45), 300 mg (n = 45), or placebo (n = 45) orally 1 hour before induction of anesthesia for an elective cesarean section to reduce postoperative analgesia requirements. Three infants of mothers in the pregabalin 300 mg group had difficulty latching on for breastfeeding for 8 hours after delivery although none were sedated.[ 6 ]
Levels in milk
In published reports of anticonvulsant use during breastfeeding, most women were taking a combination of anticonvulsants. Some other anticonvulsants (e.g., phenytoin, carbamazepine) stimulate the metabolism of other drugs including anticonvulsants, whereas others (e.g., valproic acid) inhibit the metabolism of other drugs. Therefore, the relationship of the maternal dosage to the concentration in breastmilk can be quite variable, making calculation of the weight-adjusted percentage of maternal dosage less meaningful than for other drugs in this database Maternal Levels. In one woman, the breastmilk pregabalin level was about equal to the maternal serum concentration.[ 2 ] Ten women who averaged 35.6 weeks postpartum (range 20 to 43 weeks) were given pregabalin 150 mg every 12 hours for 4 doses. Milk samples were obtained before the last dose and 5 times during the 24 hours after the last dose. Three additional collections were made between 24 and 48 hours after the last dose in 5 of the subjects. The average peak breastmilk pregabalin concentration was 4.63 mg/L and the average breastmilk pregabalin concentration was 2.05 mg/L. The average daily infant dosage was 0.31 mg/kg, or about 7% of the maternal weight-adjusted dosage.[ 3 ] Infant Levels. The breastfed infant of a woman who was taking pregabalin (dose not specified) as an anticonvulsant during pregnancy and breastfeeding had a pregabalin serum concentration of 429 mcg/L at 48 hours postpartum, which was about 8% of the mother's serum concentration. Some of the infant's serum concentration could have been derived from transplacental passage, because the pregabalin half-life in this and another newborn averaged 17 hours.[ 2 ] A physiologically based pharmacokinetic model demonstrated that with an oral maternal dosage of 150 mg given twice daily, an exclusively breastfed infant would not attain a therapeutic plasma level of about 1.5 mg/L.[ 4 ]
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.