Safety in Lactation: Drugs for bipolar disorder and hypomania

Sarah Fenner, Acting Co-Director, Midlands and East Medicines Advice Service (Midlands site) & UK Drugs in Lactation Advisory ServicePublished

Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

Whilst valproate (valproic acid/sodium valproate) is a suitable choice for use during breast feeding, current MHRA advice states that it should not be used in women of child bearing age unless Pregnancy Prevention Programme is in place, and only if other treatments are ineffective or not tolerated. For this reason, carbamazepine is preferred first-line in breastfeeding.

Lithium must be used with extreme caution, and the mother must be able to comply with strict monitoring conditions.

With all antimanic drugs, infants should be monitored for sedation, poor feeding, behavioural effects and developmental milestones.  There is limited data on the neurodevelopmental effects of long-term exposure to these agents during breastfeeding.

Antipsychotics may also be used in the management of mania and hypomania and may, in some clinical situations, be more appropriate alternatives – see separate section