Is Zolmitriptan safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Zolmitriptan. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
Relevant published information was not found as of the revision date.
Effects on milk supply
A review of four European adverse reaction databases found 26 reported cases of painful, burning nipples, painful breasts, breast engorgement and/or painful milk ejection in women who took a triptan while nursing. Pain was sometimes intense and occasionally led to decreased milk production. Pain generally subsided with time as the drug was eliminated. The authors proposed that triptans may cause vasoconstriction of the arteries in the breast, nipples, and the arteries surrounding the alveoli and milk ducts, causing a painful sensation and a painful milk ejection re ex.[ 2 ]
Levels in milk
Zolmitriptan is metabolized to the active metabolite, N-desmethylzolmitriptan by CYP1A2 and CYP3A4. Maternal Levels. Four women who were at least 1 month postpartum used zolmitriptan to treat migraine provided one milk sample before the dose, then additional milk samples at 1, 2, 4, 8, 12 and 24 hours after the dose. One mother used a 5 mg dose by nasal spray. The other 3 mothers took 2.5 mg orally. N-desmethylzolmitriptan was undetectable ( 1 nM) in milk. The average peak milk level of 8.2 mcg/L (range 2.5 to 18.1 mcg/L) occurred from 4 to 12 hours after the dose. The average milk level was 4.6 mcg/L (range 1.5 to 10.1 mcg/L) and the half-life in milk averaged 6.5 hours. Their infants average daily dosage of zolmitriptan was 0.7 mcg/kg (range 0.2 to 1.5 mcg/kg) and their average weight-adjusted infant dosage was 2.1% (range 0.7 to 5.3%) of the maternal dose. The woman who had the highest average and peak milk levels and the highest relative and absolute infant dosages was taking propranolol concurrently, which is known to increase serum zolmitriptan levels. Excluding this woman, the other three infants average daily dosage of zolmitriptan was 0.4 mcg/kg (range 0.2 to 0.6 mcg/kg) and their average weight-adjusted infant dosage was 1% (range 0.7 to 1.4%) of the maternal dose.[ 1 ] Infant Levels. Relevant published information was not found as of the revision date.
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.