ADHD Medications with Breastfeeding?

The journey of motherhood is a unique and beautiful experience, but it can also come with its own set of challenges. For mothers diagnosed with attention deficit hyperactivity disorder (ADHD), finding a balance between managing their symptoms and caring for their newborn can be particularly demanding. One common concern is whether it is safe to use ADHD medication while breastfeeding.

LET’S ANSWER THIS QUESTION FIRST:

Q: Which of the following ADHD medication has LOWEST infant drug exposure via breast milk?

ANSWER: METHYLPHENIDATE

Relative Infant Dose: estimates infant drug exposure via breast milk. The relative infant dose is the dose received via breast milk (mg/kg/day) relative to the mother’s dose (mg/kg/day).

  • Methylphenidate has the lowest RID of 0.2- 0.4%.
  • Breastfeeding is considered acceptable when the RID is <10%.

References:

  • Aust Prescr. 2015 Oct; 38(5): 156–159.
  • Br J Clin Pharmacol. 2007 Mar; 63(3): 371–375.
  • Hale’s Medications & Mothers’ Milk, 2021: A Manual of Lactational Pharmacology.

HERE IS ONE SLIDE FROM ACADEMY PRESENTATION:

[FOR ACADEMY MEMBERS]

This chapter will be summarized in the following sections:

  • Which Stimulant is preferred with breastfeeding: Methylphenidate versus Dextroamphetamine.
  • Preferred stimulant formulation: Immediate-release versus Sustained release.
  • Preferred Non-Stimulant medication option with breastfeeding: Bupropion, Atomoxetine or Alpha agonists?
  • Which ADHD medications are contraindicated with breastfeeding?

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