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Migraine Medications and Breastfeeding
| Info on selected migraine meds |
The information summarized below is only a general overview. For
detailed information on the specific drugs, please review the references
listed below with your health care provider.
| Info
on selected meds used for migraine prevention and/or pain
relief |
|||
| Name
of medication |
AAP
approved?* |
Notes |
|
| Acetaminophen (Tylenol) | yes |
L1 (safest) |
|
| Almotriptan malate (Axert) | not reviewed |
not reviewed |
|
| Amitriptylline (Elavil, Endep) | no |
L2 (safer) |
|
| Asprin | no |
L3 (moderately safe) |
|
| Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne) | not reviewed |
L3 (moderately safe) |
|
| Caffeine | yes |
L2 (safer) |
|
| Codeine | yes |
L3 (moderately safe) |
|
| Ergot alkaloids (DHE 45, Cafergot, Wigraine, Ergostat, Ergomar) | no |
L4 (possibly hazardous)
|
|
| Frovatriptan (Frova, Migard) | not reviewed |
not reviewed |
|
| Ibuprofen (Advil, Motrin) | yes |
L1 (safest) |
|
| Isometheptene Mucate (Midrin) | not reviewed |
L3 (moderately safe) |
|
| Ketorolac (Toradol, Acular) | yes |
L2 (safer) |
|
| Metoprolol (Toprol-XL, Lopressor) | yes |
L3 (moderately safe) |
|
| Naproxen (Anaprox, Naprosyn, Aleve) | yes |
L3 (moderately safe); L4 (possibly hazardous) for chronic use |
|
| Naratriptan (Amerge) | not reviewed |
L3 (moderately safe) |
|
| Nifedipine (Adalat, Procardia) | yes |
L2 (safer) |
|
| Propranolol (Inderal) | yes |
L3 (moderately safe) |
|
| Rizatriptan (Maxalt) | not reviewed | L3 (moderately safe) | 14 |
| Sumatriptan (Imitrex) |
yes |
L3 (moderately safe) |
|
| Valproic Acid (Depakene, Depakote) | yes |
L2 (safer) |
|
| Verapamil (Calan, Isoptin, Covera-HS) | yes |
L2 (safer) |
|
| Zolmitriptan (Zomig, Zomig-ZMT) | not reviewed |
L3 (moderately safe) |
|
| *
Per the AAP Policy Statement The
Transfer of Drugs and Other Chemicals Into Human Milk, revised
September 2001. ** Per Medications' and Mothers' Milk by Thomas Hale, PhD (2002 edition). |
|||
1. Almotriptan malate (Axert) is a new drug in the same category as Sumatriptan (Imitrex). It has a relatively short half-life (3-4 hours) and reaches peak plasma level 2-4 hours after administration (see pharmacologic info). No data is currently available regarding its transfer into human milk.
2. Amitriptylline (Elavil, Endep) is listed by the AAP as a "drug whose effect on nursing infants is unknown but may be of concern." However, several studies have shown that this drug is secreted into breastmilk in very small amounts and per Hale, "no untoward effects have been reported in several studies" of breastfed babies whose mothers took this med.
3. Aspirin use is discouraged in children and nursing mothers due to the risk of Reye's syndrome and internal bleeding. The AAP lists it as a "drug associated with significant side effects and should be given with caution."
4. Fioricet (Fiorinal, Bancap, Two-dyne) contains acetaminaphen or asprin, caffeine, and butalbital. Per Hale, baby should be observed for sedation.
5. Codeine (in Tylenol #3 and #4) is AAP approved for nursing mothers but, per Hale, is probably not a good choice for mothers of premature or weakened infants. Hale suggests weakened or premature infants be observed for sedation and apnea .
6. Per Hale, use of ergot alkaloids during lactation should be strongly discouraged. The AAP lists them as "drugs associated with significant side effects and should be given with caution." Excessive dosing and prolonged use may inhibit lactation. Long term exposure is contraindicated.
7. Because better drugs exist for migraine therapy, Hale suggests that Isometheptene Mucate (Midrin) is probably not a good choice for breastfeeding mothers.
8. Per Hale, although the levels of this drug transferred to the infant are probably too low to be clinically relevant, close supervision should be used. No pediatric concerns have been reported in several studies, but observe infant for hypotension, weakness, bradycardia.
9.Aleve (Naproxen) is AAP-approved for nursing mothers, but (per Hale) should be used with caution due to its long half-life and its effect on baby's cardiovascular system, kidneys and GI tract; short-term, infrequent or occasional use is not necessarily incompatible with breastfeeding.
10. Per Hale, no pediatric concerns reported via milk, but observe infant closely for changes in liver enzymes, clinical status and platelet levels.
11. Per Hale, no pediatric concerns reported via milk, but observe infant for hypotension, bradycardia, weakness.
12. Per Hale, zolmitriptan is structurally similar to sumatriptan. It is currently unknown how much of this drug is secreted into human milk.
13. More info on frovatriptan:
- Thoughts from Dr. Hale
Manufacturer
information from Elan.com- Frovatriptan: Pharmacological Differences and Clinical Results by Alan M. Rapoport
- Frovatriptan
(Frova®): A new Triptan by Trinh Kieu
14. It is currently unknown how much of this drug is secreted into human milk. It is concentrated in rodent milk, so caution is recommended.
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| References |
Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
Hale, Thomas. Medications and Mothers' Milk, 10th Edition. Pharmasoft Medical Publishing, 2002. Dr. Hale's website is located at http://neonatal.ttuhsc.edu/lact/index.html.
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| Links for additional information |
Selected List of Medications approved
by the AAP for use in breastfeeding mothers (revised 9/01) @
Medications and Breastfeeding: References
@
Treating a Migraine while Breastfeeding by Dr. Ruth Lawrence
Midrin and Breastfeeding by Anne Norton-Krawciw, RPh, IBCLC
Migraine Headache Treatment Guidelines from the American Academy of Family Physicians and the U.S. Headache Consortium
The National Migraine Association
Page last modified:
03/03/2005
Written: 07/18/2002