Amphetamine use while Breastfeeding

Drugs containing Amphetamine: Adderall, Adderall XR

Amphetamine Levels and Effects while Breastfeeding

Summary of Use during Lactation

In dosages prescribed for medical indications, some evidence indicates that amphetamine might not affect nursing infants adversely. The effect of amphetamine in milk on the neurological development of the infant has not been well studied. It is possible that large dosages of amphetamine might interfere with milk production, especially in women whose lactation is not well established. Relevant published information was not found as of the revision date on the safety of breastfeeding during amphetamine abuse.

Drug Levels

Maternal Levels. A nursing woman was taking racemic amphetamine 5 mg orally 4 times daily at 10 am, noon, 2 pm and 4 pm for narcolepsy. Trough milk levels of 55 and 68 mcg/L were found before the 10 am dose on days 10 and 42 postpartum, respectively. Milk levels were 118 and 138 mcg/L before the 2 pm doses on days 10 and 42, respectively.[1]

Infant Levels. Amphetamine was measured in a 12-hour urine collection in a breastfed infant whose mother was taking racemic amphetamine 5 mg 4 times daily. The infant's urinary excretion of amphetamine ranged from 0.1 to 0.3% of the mother's urinary excretion.[1]

Effects in Breastfed Infants

One infant whose mother was being treated for narcolepsy with racemic amphetamine 5 mg 4 times daily was exposed to the drug in milk for the (unspecified) duration of breastfeeding. There were no signs of abnormal development during the first 2 years of life.[1]

Effects on Lactation and Breastmilk

In 2 papers by the same authors, 20 women with normal physiologic hyperprolactinemia were studied on days 2 or 3 postpartum. Eight received dextroamphetamine 7.5 mg intravenously, 6 received 15 mg intravenously and 6 who served as controls received intravenous saline. The 7.5 mg dose reduced serum prolactin by 25 to 32% compared to control, but the difference was not statistically significant. The 15 mg dose significantly decreased serum prolactin by 30 to 37% at times after the infusion. No assessment of milk production was presented.[2][3] The authors also quoted data from another study showing that a 20 mg oral dose of dextroamphetamine produced a sustained suppression of serum prolactin by 40% in postpartum women. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.

In a retrospective Australian study, mothers who used intravenous amphetamines during pregnancy were less likely to be breastfeeding their newborn infants at discharge than mothers who abused other drugs (27% vs 42%). The cause of this difference was not determined.[4]

Alternate Drugs to Consider

(Therapeutic use) Dextroamphetamine, Lisdexamfetamine, Methylphenidate

References

1. Steiner E, Villen T, Hallberg M et al. Amphetamine secretion in breast milk. Eur J Clin Pharmacol. 1984;27(1):123-4. PMID: 6489423

2. DeLeo V, Cella SG, Camanni F et al. Prolactin lowering effect of amphetamine in normoprolactinemic subjects and in physiological and pathological hyperprolactinemia. Horm Metab Res. 1983;15:439-43. PMID: 6642414

3. Petraglia F, De Leo V, Sardelli S et al. Prolactin changes after administration of agonist and antagonist dopaminergic drugs in puerperal women. Gynecol Obstet Invest. 1987;23:103-9. PMID: 3583091

4. Oei JL, Abdel-Latif ME, Clark R et al. Short-term outcomes of mothers and infants exposed to antenatal amphetamines. Arch Dis Child Fetal Neonatal Ed. 2010;95:F36-F41. PMID: 19679891

Amphetamine Identification

Substance Name

Amphetamine

CAS Registry Number

300-62-9

Drug Class

Adrenergic Agents

Central Nervous System Stimulants

Dopamine Agents

Sympathomimetics

Administrative Information

LactMed Record Number

433

Last Revision Date

20130907

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