From the Guidelines
Ativan (lorazepam) 1mg sublingual can be used as a one-time dose for an acute anxiety attack in a breastfeeding mother, but caution is advised. For occasional, single-dose use, the risk to the nursing infant is generally low, as seen with other medications that are transferred to breast milk in small amounts, such as morphine 1. The medication does pass into breast milk, but in small amounts, especially when used infrequently. If possible, the mother should time the dose right after breastfeeding and then wait 4-6 hours before nursing again to minimize infant exposure.
Key Considerations
- Side effects to watch for in the infant include sedation, poor feeding, or unusual sleepiness.
- For recurring anxiety, non-medication approaches like deep breathing, mindfulness, or cognitive behavioral therapy should be considered first, or consultation with a healthcare provider about medications with better safety profiles for regular use during breastfeeding.
- The provided guidelines on anaesthesia and sedation in breastfeeding women 1 do not specifically address the use of lorazepam, but they do emphasize the importance of caution and monitoring when using any medication during breastfeeding.
Monitoring and Follow-up
It is essential to monitor the infant for any signs of sedation or other adverse effects and to follow up with a healthcare provider if the anxiety is severe or persistent. The healthcare provider can provide comprehensive evaluation and management, including considering alternative medications or therapies that may be safer for use during breastfeeding.
From the FDA Drug Label
Lorazepam has been detected in human breast milk; therefore, it should not be administered to breast-feeding women, unless the expected benefit to the woman outweighs the potential risk to the infant. Sedation and inability to suckle have occurred in neonates of lactating mothers taking benzodiazepines Infants of lactating mothers should be observed for pharmacological effects (including sedation and irritability). You should not breastfeed while taking lorazepam tablets.
The use of lorazepam as a one-time dose for an acute anxiety attack in a breastfeeding woman is not recommended due to the potential risk of sedation and inability to suckle in the infant. However, if the expected benefit to the woman outweighs the potential risk to the infant, it may be considered. The infant should be observed for pharmacological effects. 2 2
From the Research
Benzodiazepine Use During Breastfeeding
- The use of benzodiazepines, such as lorazepam, during breastfeeding has been studied, and the results suggest that the amount of drug transferred to the breast milk is small 3.
- The relative infant dose (RID) of lorazepam was found to be less than 10%, which is considered safe for breastfeeding infants 3.
- However, it is essential to consider the individual circumstances of the mother and infant, as well as the specific benzodiazepine being used, when making decisions about breastfeeding and medication use.
Lorazepam and Breastfeeding
- Lorazepam is a benzodiazepine that has been used to treat anxiety and insomnia in breastfeeding women 4.
- The drug has been shown to be transferred into breast milk, but the amount is considered to be small and compatible with breastfeeding 3.
- However, the safety of lorazepam for breastfeeding infants has not been extensively studied, and more research is needed to fully understand its effects.
Acute Anxiety Attack Treatment
- For a woman experiencing an acute anxiety attack while breastfeeding, a one-time dose of lorazepam may be considered as a treatment option 4.
- However, it is crucial to weigh the potential benefits of the medication against the potential risks to the breastfeeding infant and to consider alternative treatment options, such as non-pharmacological interventions or other medications with a more established safety profile during breastfeeding.
Breastfeeding and Anxiety
- Breastfeeding can have a positive effect on anxiety symptoms in mothers, and support for breastfeeding may help reduce the risk of postpartum depression and anxiety 5.
- However, the relationship between breastfeeding and anxiety is complex, and more research is needed to fully understand the effects of breastfeeding on maternal mental health.