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Using gabapentin or pregabalin during breastfeeding

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Topics: Anaesthesia and painGabapentinNeurological disorders · PregabalinSafety in Breastfeeding ·

Gabapentin or pregabalin can be used while breastfeeding with infant monitoring; gabapentin is preferred. Recommendations apply to full term, healthy infants.

Contents

  1. General considerations
  2. Additional medicines
  3. Recommendations
    1. Choice considerations
  5. Co-sleeping advice
  6. Neonatal withdrawal
  7. Specific recommendations
    1. Gabapentin
    2. Pregabalin
  9. Patient Information
  10. Contact us
  11. About our recommendations
  12. Bibliography
  13. 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.

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

Preferred choice

Gabapentin is preferred if clinically appropriate. Precautionary infant monitoring is still required.

Infant monitoring

As a precaution, monitor the infant for potential side-effects including drowsiness, changes in feeding (including not waking to feed) and adequate weight gain, gastro-intestinal disturbances (such as vomiting, diarrhoea, and constipation), irritability, and tremor.

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

Limited evidence shows gabapentin transfers into breast milk in very small amounts.

Infant levels of gabapentin after breastfeeding have either been undetectable or very low.

There are no published reports of side effects in breastfed infants exposed to gabapentin. All exposed infants have developed normally. There are no data looking at longer term infant effects.

Use with caution

Pregabalin is compatible with breastfeeding with precautionary infant monitoring. But, if clinically appropriate, gabapentin is preferred.

Infant monitoring

As a precaution, monitor the infant for potential side-effects including drowsiness, changes in feeding (including not waking to feed), putting on weight as expected, gastro-intestinal disturbances (including vomiting, diarrhoea, and constipation), and irritability.

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

Very limited evidence shows pregabalin transfers into breast milk in small amounts.
Pregabalin was detected in the serum of one infant, although this could have been due to transplacental passage.

There are very few published cases of infants exposed to pregabalin through breastmilk but no side effects have been reported. There are no data looking at longer term infant effects.

Pharmacokinetic modelling predicts that a maternal dose of 300 mg daily will not result in therapeutic levels in exclusively breastfed infants.

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

  1. Republished
  2. Full clinical review and update
  1. Minor title amendment
  1. Published