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.
Additional medicines
Gabapentin and pregabalin can be used for multiple indications. Medicines from different pharmacological classes may be used in combination and their additive suitability in breastfeeding will need to be considered. See our advice on other relevant medicines in breastfeeding (SPS page).
In these situations, consider contacting our specialist service (SPS page) for further advice.
Recommendations
Both gabapentin and pregabalin are compatible with breastfeeding.
Gabapentin is the preferred choice, as there is more published evidence of its use during breastfeeding. There are no data on long term developmental effects for gabapentin or pregabalin from infant exposure via breast milk.
Choice considerations
Treatment choice should primarily focus on managing the underlying condition with suitability in breastfeeding as a secondary consideration.
There is no need to change treatment to gabapentin if pregabalin has been used successfully during pregnancy.
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. This includes when parents have taken sedating medicines such as antipsychotics.
NICE therefore advises avoiding sharing a bed with the infant when sedating medicines are used. Further information can be found in Co-sleeping and SIDS: A guide for healthcare professionals (UNICEF UK).
Neonatal withdrawal
Withdrawal symptoms and poor neonatal adaptation syndrome have been associated in infants exposed to gabapentin or pregabalin in pregnancy. This is more likely to occur for exposure near delivery or when more than one centrally acting medicine is used.
Continuing breastfeeding may theoretically help relieve withdrawal effects but does not reduce the risk completely.
Specific recommendations
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:
- the infant is unwell or premature
- multiple medicines are being taken
- you need further advice
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 are 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
- Republished
- Full clinical review and update
- Minor title amendment
- Published