From the Guidelines
Most neuropathic pain medications can be used during breastfeeding, but it is crucial to weigh the benefits of pain control against potential risks to the infant, with gabapentin and pregabalin being generally considered relatively safe options. When considering the safety of neuropathic pain medications during breastfeeding, it's essential to evaluate the potential risks and benefits for both the mother and the infant. According to the most recent and highest quality study 1, gabapentin and pregabalin have minimal transfer into breast milk and are considered relatively safe options.
Key Considerations for Neuropathic Pain Medications During Breastfeeding
- Gabapentin and pregabalin are generally considered safe due to their minimal transfer into breast milk, as supported by studies such as 1 and 1.
- Tricyclic antidepressants like amitriptyline and nortriptyline require monitoring for infant sedation, as noted in 1.
- SSRIs and SNRIs (duloxetine, venlafaxine) are generally acceptable but may cause irritability or feeding difficulties in some infants, as discussed in 1.
- Topical treatments like lidocaine patches or capsaicin cream are preferred when appropriate since they have minimal systemic absorption, as suggested in 1.
- Opioids should be used cautiously and only for short periods due to risks of infant sedation and respiratory depression, as warned in 1.
Recommendations for Breastfeeding Mothers with Neuropathic Pain
- Consult with a healthcare provider to determine the best course of treatment, considering the individual circumstances and the potential risks and benefits of each medication.
- Monitor the infant for any signs of adverse effects, such as sedation or changes in feeding patterns, when using medications like tricyclic antidepressants or opioids.
- Consider the timing of medication relative to breastfeeding to minimize infant exposure, as suggested in 1.
- Prioritize non-pharmacological interventions and lifestyle modifications to manage neuropathic pain, when possible, to reduce the need for medication.
From the FDA Drug Label
Based on animal studies, there is a potential risk of tumorigenicity with pregabalin exposure via breast milk to the breastfed infant Because of the potential risk of tumorigenicity, breastfeeding is not recommended during treatment with pregabalin.
Neuropathic pain medications, specifically pregabalin, are not safe during breastfeeding due to the potential risk of tumorigenicity to the breastfed infant 2.
From the Research
Safety of Neuropathic Pain Medications during Breastfeeding
- There is limited information available on the safety of neuropathic pain medications during breastfeeding 3, 4.
- Some studies suggest that certain medications, such as antidepressants and anticonvulsants, may be used to treat neuropathic pain, but their safety during breastfeeding is not well established 3, 4.
- The use of medications during breastfeeding should be approached with caution, and healthcare providers should consider the risk-benefit ratio of taking a medication versus terminating breastfeeding 5.
- It is recommended that healthcare providers adopt evidence-based practices for breastfeeding and breastfeeding pain management, including the use of medications, to support women in successfully reaching their breastfeeding goals 6, 7.
- Monitoring for excessive sedation and other adverse effects in infants is prudent for women who are prescribed opiates or other medications that may increase sedation 7.
Medication Options for Neuropathic Pain during Breastfeeding
- First-line drugs for neuropathic pain include antidepressants (tricyclic antidepressants and serotonin-noradrenaline reuptake inhibitors) and anticonvulsants acting at calcium channels (pregabalin and gabapentin) 3, 4.
- Second- and third-line drugs for neuropathic pain include topical lidocaine and opioids, but their use during breastfeeding should be approached with caution due to potential adverse effects 3, 7.
- Nonpharmacological measures, such as behavioral, cognitive, integrative, and physical therapies, may also be effective in managing neuropathic pain during breastfeeding 4.