Safety in Lactation: Drugs for sleeping disorders

Additional information relating to breastfeeding

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

Hypnotics

Use of hypnotic agents in breastfeeding mothers should be approached with caution.

Benzodiazepines tend to have long half-lives and could potentially accumulate in the breastfed infant following prolonged administration, leading to possible sedation and increased risk of apnoea.

The ‘z’ hypnotics are preferred, as they have shorter half-lives than the benzodiazepines and appear to pass into breast milk in small amounts.

Several benzodiazepines are described as short-acting, but have significantly longer half-lives compared to the ‘z’ hypnotics.

Where possible use short-term, intermittent dosing to reduce infant exposure.

Monitor the infant closely for drowsiness, poor feeding and adequate weight gain.

Co-sleeping should be discouraged when the mother has taken a hypnotic.

Drugs for narcolepsy

The preferred drug for narcolepsy in breastfeeding mothers is dexamfetamine, although the evidence for safety in breastfeeding is limited. Infants should be monitored for symptoms of CNS stimulation (except sodium oxybate), although these may be difficult to detect. High doses may interfere with lactation, although this is not confirmed in practice.

Chloral hydrateClomethiazoleDexamfetamineFlurazepamLoprazolamLormetazepamMelatoninMental health and illnessModafinilNitrazepamObstetrics and gynaecologyPaediatric and neonatal medicinePromethazine hydrochlorideSafety in LactationSodium oxybateTemazepamZaleplonZolpidemZopiclone