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Treating urinary disorders during breastfeeding

Last updated See all updates
Topics: DuloxetineMirabegronOxybutynin · Renal and urologic disordersSafety in BreastfeedingSolifenacinTolterodine ·

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. Co-sleeping advice
  5. Specific recommendations
    1. Oxybutynin
    2. Duloxetine
    3. Mirabegron
    4. Solifenacin
    5. Tolterodine
  7. Patient Information
  8. Contact us
  9. About our recommendations
  10. Bibliography
  11. 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 favourable pharmacokinetic properties.

Effect on breastfeeding

There is a small risk of decreased milk production with anticholinergic medicines (oxybutynin, solifenacin, 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, such as poor weight gain.

Co-sleeping advice

Sudden infant death syndrome (SIDS) is very rare, and breastfeeding reduces the risk. However, it is much more likely to happen in certain circumstances, including when parents have taken sedating medicines (oxybutynin, duloxetine, tolterodine and solifenacin).

NICE therefore advises avoiding sharing a bed with the infant when sedating medication has been used. Further information can be found in Co-sleeping and SIDS: A guide for healthcare professionals (UNICEF UK).

Specific recommendations

Preferred choice

Oxybutynin is the preferred choice during breastfeeding, but infant monitoring is still required.

Infant monitoring

As a precaution, monitor the infant for potential side effects including drowsiness, insomnia, irritability, gastro-intestinal effects, urinary retention (decrease in wet nappies), dry mouth, poor feeding and adequate weight gain.

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence for use during breastfeeding. Milk levels have not been measured.

Based on its pharmacokinetic properties, it is likely to be found in breastmilk in very low levels. Its low oral bioavailability will further limit absorption by the infant. Infant side effects are therefore unlikely.

Use with caution

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

Using certain antidepressants during breastfeeding (SPS page) provides additional information on the use of duloxetine during breastfeeding. 

Use with caution

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

Monitoring

As a precaution, monitor the infant for potential side effects including irritability, gastrointestinal disturbances, urinary retention (decrease in wet nappies), poor feeding and adequate weight gain.
Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breastfeeding. Milk levels have not been measured.

Based on its pharmacokinetic properties, it is likely to be found in breastmilk in low levels. Its relatively low oral bioavailability will further limit absorption by the infant. Although side effects are unlikely, mirabegron has a long half-life, increasing the risk of accumulation in the breastfed infant, which may increase the risk of side effects.

Use with caution

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

Infant monitoring

As a precaution, monitor the infant for potential side effects including drowsiness, irritability, gastrointestinal disturbances, urinary retention (decrease in wet nappies), dry mouth, poor feeding and adequate weight gain.

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use in breastfeeding. Milk levels have not been measured.

Based on its pharmacokinetic properties, it is likely to be found in breastmilk in low levels. Although side effects are unlikely, solifenacin has a long half-life, increasing the risk of accumulation in the breastfed infant which may increase the risk of side effects.

Use with caution

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

Infant monitoring

As a precaution, monitor the infant for potential side effects including drowsiness, irritability, gastrointestinal disturbances, urinary retention (decrease in wet nappies), dry mouth, poor feeding and adequate weight gain.

Monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use in breastfeeding. Milk levels have not been measured.

Based on its pharmacokinetic properties, it is likely to be found in breastmilk in very low levels. Its low oral bioavailability will further limit absorption by the infant so, side effects are unlikely.

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. Republished
  2. Full Clinical review and update
  1. Update to mirabegron re amount likely to pass into milk.
  1. Minor title amendment
  1. Published