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Treating urinary disorders during breastfeeding

Published Last updated See all updates
Topics: DarifenacinDuloxetineMirabegron · OxybutyninRenal and urologic disordersSafety in BreastfeedingTolterodine ·

Oxybutynin is preferred for urinary disorders during breastfeeding. Recommendations apply to full term and healthy infants only.

Contents

  1. General considerations
  2. Recommendation
  3. Effect on breastfeeding
  4. Specific recommendations
    1. Oxybutynin
    2. Darifenacin
    3. Duloxetine
    4. Mirabegron
    5. Tolterodine
  6. Patient Information
  7. Contact us
  8. About our recommendations
  9. Bibliography
  10. Update history

General considerations

It is important to complete an individual risk assessment (SPS page) for your patient and to apply the principles of prescribing in breastfeeding (SPS page) when looking at the available information and making treatment decisions.

Recommendation

Oxybutynin is the preferred choice for treating urinary frequency, urgency and urge incontinence due to its short half-life.

Effect on breastfeeding

There is a small risk that milk production could be decreased with medicines with an anticholinergic action (oxybutynin, darifenacin, and tolterodine), although there is no published evidence to support this.

Breastfed infants should be monitored for signs of the effects of decreased milk production if these medicines are used long term, e.g. poor weight gain.

Specific recommendations

Preferred choice

Oxybutynin is the preferred choice due to anticipated low levels in breast milk and favourable medicine properties.

Infant monitoring

As a precaution, monitor the infant for anticholinergic effects, e.g. urinary retention, colic and constipation. If used long term, monitor for signs of decreased milk production, e.g. poor infant weight gain.

Further information

There is no published evidence of use during breastfeeding.

Use with caution

Darifenacin can be used with caution during breastfeeding, but oxybutynin preferred.

Infant monitoring

As a precaution, monitor the infant for anticholinergic effects, e.g. urinary retention, colic and constipation. If used long term, monitor for signs of decreased milk production, e.g. poor infant weight gain.

Further information

There is no published evidence of use during breastfeeding. Low levels are anticipated in milk due to the medicine’s properties, although the long half-life increases the risk of accumulation in breastfed infants.

Use with caution

Duloxetine can be used with caution during breastfeeding, but oxybutynin is preferred.

Infant monitoring

As a precaution, monitor the infant for drowsiness, poor feeding, irritability, and restlessness.

Further information

There is limited published evidence of use during breastfeeding. This shows that duloxetine passes into breast milk in very small amounts, but is then likely to be degraded in infant’s gastro-intestinal tract. However, the long half-life increases the risk of accumulation in breast fed infants.

Use with caution

Mirabegron can be used with caution during breastfeeding, but oxybutynin is preferred.

Monitoring

As a precaution, monitor the infant for gastro-intestinal disturbances and urinary tract infections.

Further information

There is no published evidence of use during breastfeeding. The long half-life increases the risk of accumulation in breastfed infants, although low amounts are predicted to pass through into breast milk based on the medicine’s properties.

Use with caution

Tolterodine can be used with caution during breastfeeding, but oxybutynin preferred.

Infant monitoring

As a precaution, monitor the infant for anticholinergic effects, e.g. urinary retention, colic and constipation. If used long term, monitor for signs of decreased milk production, e.g. poor infant weight gain.

Further information

There is no published evidence for use in breastfeeding.

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS) (SPS page), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.

Update history

  1. Update to mirabegron re amount likely to pass into milk.
  1. Minor title amendment
  1. Published