Pregabalin and breastfeeding

Pregabalin and breastfeeding

• pregabalin can be used while breastfeeding, but with caution and infant monitoring
• there is very limited published evidence for the use of pregabalin in breastfeeding
  • limited data indicate that amounts of pregabalin in breastmilk are low and one infant breastfed for 3 months with no discernable adverse effects (2)
    • if pregabalin is required by the mother of an older infant, it is not a reason to discontinue breastfeeding, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant

Milk levels and infant absorption

• the drug properties of pregabalin enable it to pass into breast milk
• is a small molecule and does not bind to proteins, therefore there are lots of free drug molecules to pass into milk
• data from one study shows that levels in milk are low and estimated at around 7% of the weight-adjusted maternal dose
• a further study has demonstrated that infant serum levels are also low, and estimated to be around 8% of the maternal serum level (1)

Effects in infants

• have been no adverse effects, reported in any of the infants exposed to date. Due to the low levels reported in breast milk and infant serum, side-effects would not be expected
• are no data looking at long term infant effects

Monitoring the infant

• although adverse effects are highly unlikely from gabapentin or pregabalin exposure via breast milk, as a precaution monitor the infant for:
  • feeding; the infant should be feeding well and continue to gain weight as expected
  • over sleepy; for example, not waking to feed or sleeping for longer and more often than expected
  • slowed breathing
  • gastro-intestinal disturbances, including diarrhoea and constipation
• monitoring the infant will quickly pick up any potential issues, but usually further investigation is required before the cause can be identified
• if any of these adverse effects occur, the mother should contact a healthcare professional for advice.

Reference:

• NHS Specialist Pharmacy Service (March 2022). Using gabapentin or pregabalin whilst breastfeeding
• Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Pregabalin. [Updated 2021 Jul 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501821/