Gabapentin and pregabalin—are they safe whilst breastfeeding?

This UKMi Medicines Q & A reviews the evidence available, and makes recommendations, for the use of gabapentin and pregabalin during breastfeeding.

Summary:

  • Limited data indicate that gabapentin passes into breast milk, with low or negligible concentrations measured in the breastfed infant’s serum.
  • The infant dose of gabapentin via breast milk has been estimated to be 1.3–3.8% of the maternal weight-adjusted dosage.
  • Gabapentin use during breastfeeding can therefore proceed, with adequate infant monitoring.
  • Evidence for the use of pregabalin during breastfeeding is limited, A single study reported extensive passage of pregabalin (dose not specified) into breast milk but low levels in the infant serum. However, a slightly larger study has estimated the infant dose of pregabalin to be 7% of the maternal weight-adjusted dosage.
  • Therefore, due to limited data for pregabalin, alternative agents for which more data exists should be used preferentially, especially in a newborn infant. However, this may not always be therapeutically possible.
  • No adverse effects have been attributed to infant exposure to gabapentin or pregabalin through the breast milk.
  • If gabapentin or pregabalin is used by a breastfeeding mother, monitor the infant for gastrointestinal adverse effects, appetite changes, adequate weight gain, drowsiness and normal developmental milestones. If the infant becomes unwell then consider withholding breastfeeding until a cause can be identified.
  • Gabapentin and pregabalin are almost entirely renally excreted; therefore, where possible, use should be avoided in infants with impaired renal function and premature infants.
  • Long-term data on the developmental effects of exposure to gabapentin through breast milk is limited, although a meta-analysis does not associate gabapentin with cognitive or psychomotor development delay. There is no available long-term data for pregabalin.
GabapentinObstetrics and gynaecologyPaediatric and neonatal medicinePregabalinQ&ASafety in Lactation

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