Methylphenidate use while Breastfeeding
Drugs containing Methylphenidate: Ritalin, Concerta, Daytrana, Quillivant XR, Metadate CD, Methylin, Ritalin LA, Metadate ER, Methylin ER, Ritalin-SR
Methylphenidate Levels and Effects while Breastfeeding
Summary of Use during Lactation
In dosages prescribed for medical indications, limited evidence indicates that methylphenidate levels in milk are very low and might not affect nursing infants adversely. The effects of methylphenidate in milk on the neurological development of the infant have not been well studied. It is possible that large dosages of methylphenidate might interfere with milk production, especially in women whose lactation is not well established.
Maternal Levels. Three mothers were taking methylphenidate in an average dosage of 52 mg daily (range 35 to 80 mg daily) for attention deficit hyperactivity disorder. The average milk level was 19 mcg/L which resulted in an infant dosage of 2.9 mcg/kg daily or 0.7% of the maternal weight-adjusted dosage.
The same authors reported a nursing mother who was taking methylphenidate, but it is unclear if this patient is one of those reported above. The mother was taking 40 mg twice daily, 5 days/week for 5.5 weeks prior to testing, but for 7 consecutive days immediately before collecting blood and milk samples after a morning dose of 40 mg. The average milk level of methylphenidate over the 24 hours after the dose was 15.4 mcg/L. The infant was calculated to receive 2.3 mcg/kg daily which was 0.2% of the maternal weight-adjusted dosage.
A woman who was 11 months postpartum was taking oral immediate-release methylphenidate 5 mg in the morning and 10 mg at noon. The drug was undetectable (<0.3 mcg/L) before the morning dose and 21 hours after the noon dose. Three other levels ranged from1.7 to 3.8 mcg/L. The authors estimated that a fully breastfed infant would receive a dose of 0.38 mcg/kg daily or 0.16% of the maternal weight-adjusted dosage.
A woman was taking 72 mg daily of slow-release methylphenidate. The drug was undetectable (assay limit not stated) in breastmilk at 6 to 12 months postpartum.
Infant Levels. Methylphenidate blood levels were measured in 2 breastfed infants. These were 2 of 3 infants whose mothers were taking an average of 52 mg daily of methylphenidate. The drug was undetectable (<1 mcg/L) in the infants' blood; however, the corresponding maternal dosages and times of blood collection were not stated in the abstract.
A 6.4-month-old partially breastfed infant had been breastfed for 5.5 weeks by a mother taking methylphenidate 40 mg twice daily. The drug was undetectable (<1 mcg/L)in the infant's plasma 5.3 hours after the mother's dose and having been breastfed 4 times since the dose. This patient might have been one of those in the report above by the same authors.
An infant was born to a mother with attention deficit-hyperactivity disorder who took a tapering dose of methylphenidate before and during pregnancy. The drug was stopped 10 days prior to delivery, but restarted after 5 weeks postpartum. Methylphenidate was undetectable (assay limit not stated) in the infant's blood between 6 and 2 months of age when the mother was taking a dose of 72 mg of slow-release methylphenidate daily. The extent of breastfeeding was not stated.
Effects in Breastfed Infants
Seven of 8 infants, whose mothers were taking either dextroamphetamine (average dosage 25 mg daily) or methylphenidate (average dosage 52 mg daily) were clinically evaluated. The infants had no drug-related adverse reactions and were developing normally for their ages which averaged 4.4 months.
One 6.4-month-old infant was mostly breastfed by a mother who had been taking methylphenidate 40 mg twice daily 5 days/week for 5.5 weeks. The mother reported that the infant was sleeping, eating and gaining weight normally. This patient might have been one of those in the report above by the same authors.
An infant was being breastfed (extent not stated) by a mother who began taking sertraline 50 mg daily and methylphenidate after 5 weeks postpartum. Dosage was started at 10 mg daily with an immediate-release product and gradually increased to 72 mg daily of an extended-release product. At 14 weeks of age, the infant was developing normally no feeding difficulties. Examinations at 6 months and 1 year of age found no developmental problems in the child.
Effects on Lactation and Breastmilk
Methylphenidate reduces serum prolactin, but no studies have been located as of the revision date on the effect of methylphenidate on milk production. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Alternate Drugs to Consider
1. Hackett LP, Ilett KF, Kristensen JH et al. Infant dose and safety of breastfeeding for dexamphetamine and methylphenidate in mothers with attention deficit hyperactivity disorder. Ther Drug Monit. 2005;27:220-1. Abstract.
2. Hackett LP, Kristensen JH, Hale TW, Paterson R, Ilett KF. Methylphenidate and breast-feeding. Ann Pharmacother. 2006; 40:1890-1. PMID: 16940409
3. Spigset O, Brede WR, Zahlsen K. Excretion of methylphenidate in breast milk. Am J Psychiatry. 2007;164:348. PMID: 17267805
4. Bolea-Alamanac BM, Green A, Verma G et al. Methylphenidate use in pregnancy and lactation: a systematic review of evidence. Br J Clin Pharmacol. 2014;77:96-101. PMID: 23593966
5. Upadhyaya HP, Brady KT, Liao J et al. Neuroendocrine and behavioral responses to dopaminergic agonists in adolescents with alcohol abuse. Psychopharmacology (Berl). 2003;166:95-101. PMID: 12520313
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