Gabapentin

Gabapentin is considered compatible with breastfeeding, but should be used with caution and infant monitoring.

Evidence

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.

Breast milk levels and infant absorption

Gabapentin is a small molecule with low protein binding, which enables it to pass into breast milk. However, 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

There 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.

There are no data looking at long term infant effects.

Pregabalin

Pregabalin can be used while breastfeeding, but with caution and infant monitoring.

Evidence

There is very limited published evidence for the use of pregabalin in breastfeeding. Evidence comes from 13 breastfeeding mothers, using doses of up to 300mg daily.

Breast milk levels and infant absorption

The drug properties of pregabalin enable it to pass into breast milk. It is a small molecule and does not bind to proteins, therefore there are lots of free drug molecules to pass into milk. However, 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.

Effects in infants

There 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.

There 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.

Further Advice

Recommendations apply to full-term and healthy infants. If the infant was born prematurely, is unwell, or the mother is taking multiple medicines, contact the UK Drugs in Lactation Advisory Service.