I am breastfeeding my four month old daughter. I suffer from a seizure disorder that occasionally causes me to jerk and clonazepam can help. I take about three per week maximum and my dosage is 0.5mg (relatively small). Everyone has a different opinion and I was wondering if anyone else knows if it’s okay. My pharmacist says it’s okay in such small dosages, my neurologist isn’t sure and knows just what the large drug book says etc… I want to do what’s best for my daughter and I only take it on an “as needed” basis. I am afraid I’ll have to stop breastfeeding because having a seizure can be even more dangerous.
October 12th, 2009 at 5:47 pm
The neurologist is probably looking it up in the PDR (physician’s desk reference) or the CPS (Compendium of Pharmaceuticals
and Specialities) neither of which are considered accurate sources for safety information about prescription use during lactation.
The pharmacist is probably using “Medications and Mother’s Milk” by Thomas Hale which is THE book for safety information. You can ask to see their copy they should be happy to let you read it maybe even copy it for you. Some libraries also have it, you can buy it yourself but its rather expensive. Your doctors can request further information on Hale’s website, sadly he had to stop taking questions from patients. (Anticonvulsant Medications
Dr. Hale’s Breastfeeding and Medications Forum > http://neonatal.ttuhsc.edu/discus/messag… )
Another good source is Motherisk which would be happy to take calls from your or your neurologist no matter where you are calling from. They can discuss your dosage, the age of the baby, and possibly other drugs that are safer or more studied: (416) 813-6780 Monday to Friday 9-5 EST
If you remain concerned any doctor could check the blood level of the drug in your baby.http://toxnet.nlm.nih.gov/cgi-bin/sis/se…
Summary of Use during Lactation:
Only a small number of cases of breastfeeding with clonazepam have been reported. If clonazepam is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Monitoring of the infant’s serum concentration may be indicated if excessive sedation occurs.http://neonatal.ttuhsc.edu/discus/messag…
Glenda:
I think its probably OK, as long as the infants are closely observed for the first few days. See my revised monograph (MMM2008) below for clonazepam.
Tom Hale Ph.D.
——MMM2008 —-
Clonazepam is a typical benzodiazepine sedative, anticonvulsant. In one case report, milk levels varied between 11 and 13 µg/L (the maternal dose was omitted).[1] Milk/maternal serum ratio was approximately 0.33. In this report, the infant’s serum level of clonazepam dropped from 4.4 µg/L at birth to 1.0 µg/L at 14 days while continuing to breastfeed, suggesting increasing clearance with time.
Another study of a mother treated with 2 mg clonazepam twice daily recorded peak milk concentrations of 10.7 µg/L at 4 hours post dose, and a maximum infant dose of 2.5% of the weight adjusted maternal dose. The infant’s serum level of clonazepam at days 2-4 was 4.7 µg/L.[2]
In a group of 11 mothers receiving 0.25 to 2 mg clonazepam daily, ten of 11 breastfed infants had no detectable (limit of detection: 5-14 ug/L) clonazepam or metabolites in their serum.[3] On infant (1.9 weeks old) had a serum concentration of 22 ug/L. Maternal dose was 0.5 mg daily.
These data suggest the low incidence of toxicity with this medication in breastfeeding infants.
OBservations:
Apnea, cyanosis and hypotonia was reported in one infant at 6 hours postnatally to a woman consuming clonazepam throughout pregnancy. Maternal and cord serum levels of clonazepam were 32 ng/mL and 19 ng/mL respectively. The infant had prolonged apnea and hypotonia. The infant had repeated periodic breathing episodes up to 10 weeks of age.[1] In another group of 11 mothers consuming clonazepam, none of the infants had any reported side effects.[3]
1.Fisher JB, Edgren BE, Mammel MC, Coleman JM. Neonatal apnea associated with maternal clonazepam therapy: a case report. Obstet Gynecol 1985; 66(3 Suppl):34S-35S.
2.Soderman P, Matheson I. Clonazepam in breast milk. Eur J Pediatr 1988; 147(2):212-213.
3.Birnbaum CS, Cohen LS, Bailey JW et al. Serum concentrations of antidepressants and benzodiazepines in nursing infants: a case series. Pediatrics. 1999;104:e11.http://www.kellymom.com/newman/09a-drugs…
Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society. And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping.http://findarticles.com/p/articles/mi_qa…
Breastfeeding Benefits and Formula -Feeding Risks: Two Sides of the Same Coin
Infants who are formula fed are at risk for more short- and long-term health problems than are their breastfed peers (Table 1). The American Academy of Pediatrics (AAP, 1997) recommends exclusive breastfeeding for approximately the first 6 months of life, and continued breastfeeding to at least 1 year or beyond. Formula-fed infants have more allergies and incidents of asthma and wheezing (Burr et al, 1993), more episodes of diarrhea (Clemens et al, 1999), more ear infections (Duffy, Faden, Wasielewski, Wolf, & Krystofik, 1997), and are more likely to be overweight or obese entering kindergarten (Armstrong & Reilly, 2001). Children who were not breastfed as infants are at increased risk for developing childhood cancers (Davis, 1998) and type 1 insulin-dependent diabetes (Virtanen et al., 1991).
If a mother chooses (or is advised) to formula-feed, her health is at risk, too, both in the postpartum period and in the long term. Not breastfeeding increases the risk of postpartum bleeding, and women who do not breastfeed also have a greater incidence of obesity and osteoporosis later in life (Lawrence & Lawrence, 1999). Mothers who do not breastfeed significantly increase their risk of ovarian cancer (Lawrence & Lawrence), and a recent large -scale reanalysis of data from 47 different studies (including more than 500 ,0 000 women) found that mothers decreased their risk of breast cancer by 4.3% for every 12 months they breastfed (Collaborative Group, 2002). Mothers who do not breastfeed miss out on important mother -infant bonding and the empowerment many mothers find in being able to provide something positive and special for their babies (Lawrence & Lawrence). In other words, not only is “breast best,” breast is normal.
Breastfeeding and Psychotropic Drugs: General Considerations in the Healthy Full -Term Infant
[....]
Clonazepam (Klonopin). Clonazepam has a half-life of 18 to 50 hours, is 50% to 86% protein bound, and absorption in the mother is complete (Hale, 2002). Birnbaum et al. (1999) studied serum levels of clonazepam in infants who were exposed through their mothers’ milk. Of the five infants studied, only one had a detectable serum level of clonazepam. However, this infant had been exposed to the drug during pregnancy and labor, in addition to exposure through breast milk. The M/P ratio was 0.33 to 0.37. No adverse effects were reported by any of the mothers.
In a case report by Hagg & Spigset (2000), a serum concentration of 2.9 ng/ml was measured in a 7-day-old infant breastfed by clonazepam-treated mother. Again, this significant concentration was most likely a consequence of exposure in utero.
Hale (2002) included one case report of an infant’s serum level of 4.4 µg/L at birth after exposure to clonazepam in utero, which subsequently dropped to 1.0 µg/L at day of life 14 while continuing to breastfeed.
October 12th, 2009 at 11:40 pm
From Lactmed, very reliable:
“If clonazepam is required by the mother, it is not a reason to discontinue breastfeeding…”http://toxnet.nlm.nih.gov/cgi-bin/sis/se…
If you call these people:http://www.motherisk.org/women/index.jsp
you can find out pretty much everything that’s known about a given drug and breast milk.
October 13th, 2009 at 4:41 am
http://toxnet.nlm.nih.gov/cgi-bin/sis/se…
You can also find information in Thomas Hales book “Medications and Mother’s Milk.”
Good luck and don’t stop breastfeeding!!!!!