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Z drugs (zolpidem and zopiclone) in breastfeeding

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • cause of the insomnia should be identified before a medicine is prescribed and, where possible, underlying factors should be treated
  • good sleep hygiene should be established to raise awareness of behavioural, environmental and temporal factors that may be detrimental or beneficial to sleep

Any decision to treat a sleep disorder with medication needs to be carefully considered, taking into account the usual sleep deprivation associated with a newborn infant

  • use of medicines to treat insomnia during breastfeeding should be approached with caution
    • where possible use short-term, intermittent dosing, and the lowest effective dose to reduce infant exposure
  • the ‘z- drugs’ (zolpidem and zopiclone) are preferred for the short-term management of insomnia during breastfeeding, as they have shorter half-lives than the benzodiazepines and appear to pass into breast milk in small amounts (1):
    • zolpidem
      • estimated infant dose < 0.02% the maternal dose (2)
      • stated by the American Academy of Pediatrics (AAP) as safe for lactation (2)
    • zopiclone
      • estimated infant dose about 3.2% of maternal dose (2)
      • unlikely toxicity but effects of chronic exposure unknown (2)
    • melatonin can also be used in breastfeeding with caution
  • monitor the infant closely for side effects, such as drowsiness.
  • may present as not waking up to feed/falling asleep whilst feeding, which may affect weight gain
  • note that NICE advises to avoid sharing a bed with the infant when sedating medication has been used, due to the increased risk of sudden unexpected death in infancy

Reference:

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