Safety in Lactation: Drugs which enhance neuromuscular transmission

Edrophonium, neostigmine and physostigmine are anticholinesterases used in myasthenia gravis. They are largely ionised in maternal plasma and therefore unlikely to pass into breast milk in clinically significant quantities. As myasthenia gravis may cause excessive fatigue in the mother, suspension of breastfeeding may be necessary occasionally.
There is no evidence for the safety of either amifampridine for Lambert-Eaton myasthenic syndrome) or fampridine (for multiple sclerosis). An assessment of potential but unknown risk versus benefits to mother and infant should be made and the infant monitored for adverse effects related to the action of the drugs.