Gabapentin and breastfeeding

Gabapentinand breastfeeding

• gabapentin is considered compatible with breastfeeding, but should be used with caution and infant monitoring (1)
• published evidence for the use of gabapentin during breastfeeding is very limited. Data is from 10 mothers using gabapentin doses up to 2.1g daily
• limited information indicates that maternal doses of gabapentin up to 2.1 grams daily produce relatively low levels in infant serum (2)
  • monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs
  • a single oral dose of either 300 mg or 600 mg given to the mother before cesarean section appeared to have no effect on breastfeeding initiation
  • expert consensus indicates that gabapentin is an acceptable choice for refractory restless leg syndrome during lactation

Breast milk levels and infant absorption

• gabapentin is a small molecule with low protein binding, which enables it to pass into breast milk
• limited evidence shows gabapentin only transfers in small amounts
  • levels in milk are estimated to be between 1.3 and 3.8% of the weight-adjusted maternal dose
  • infant serum levels of gabapentin were either low (4-12% of the mother’s serum level) or undetectable, and would not be expected to have any effect on the infant

Effects in infants

• have been no published reports of adverse effects in infants exposed to gabapentin via breast milk
  • due to the low levels reported in breast milk and infant serum, side-effects would not be expected (1)
  • are no data looking at long term infant effects

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-. Gabapentin. [Updated 2021 Feb 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501224/