Does Wellbutrin (Bupropion) affect breastfeeding?

From the Guidelines

Yes, Wellbutrin (Bupropion) is present in human milk and can affect breastfeeding, although the levels detected in infant serum are very low and sometimes undetectable 1.

Key Points

• Bupropion has been detected in the serum of infants exposed to it via breastfeeding, but generally, no adverse events have been reported 1.
• There have been 2 case reports of seizures in breastfed infants, which warrants caution 1.
• The American Journal of Obstetrics and Gynecology suggests maintaining a therapeutic dose of bupropion during breastfeeding, while monitoring infant development carefully 1.

Breastfeeding Considerations

• If taking bupropion, it is recommended to maintain the therapeutic dose at the time of delivery and during breastfeeding, while ensuring infants are gaining weight appropriately and meeting milestones 1.
• Consider intermittent use and timing feeding or pumping to achieve the lowest concentration in human milk or other feeding options 1.

Medication Management

• Bupropion does not seem to be associated with major congenital malformations or significant adverse obstetrical outcomes, although data are limited 1.
• The usual starting dose of bupropion is 100-150 mg po daily, with a maintenance dose of 100-150 mg po BID 1.

General Principles

• The consensus is that treatment with medications, including bupropion, should not be stopped if they are required for daily functioning, given the low magnitude of documented risks 1.

From the FDA Drug Label

Data from published literature report the presence of bupropion and its metabolites in human milk (see Data). There are no data on the effects of bupropion or its metabolites on milk production. Limited data from postmarketing reports have not identified a clear association of adverse reactions in the breastfed infant The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for bupropion hydrochloride extended-release tablets (XL) and any potential adverse effects on the breastfed child from bupropion hydrochloride extended-release tablets (XL) or from the underlying maternal condition In a lactation study of ten women, levels of orally dosed bupropion and its active metabolites were measured in expressed milk. The average daily infant exposure (assuming 150 mL/kg daily consumption) to bupropion and its active metabolites was 2% of the maternal weight-adjusted dose. Postmarketing reports have described seizures in breastfed infants. The relationship of bupropion exposure and these seizures is unclear.

Bupropion is present in human milk, and the average daily infant exposure is 2% of the maternal weight-adjusted dose 2. However, there are limited data on the effects of bupropion on milk production and the breastfed infant. While some postmarketing reports have described seizures in breastfed infants, the relationship between bupropion exposure and these seizures is unclear. Therefore, the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for bupropion and any potential adverse effects on the breastfed child.

From the Research

Effects of Wellbutrin (Bupropion) on Breastfeeding

• The study 3 found that neither infant had quantifiable serum levels of bupropion or its metabolite at steady state, suggesting that bupropion may not be present in significant amounts in breast milk.
• However, the study 4 reported a case of seizure-like symptoms in an infant exposed to bupropion and escitalopram through breastfeeding, indicating potential adverse effects.
• The review 5 states that medications used to treat depression, including bupropion, are secreted in breast milk to some extent, but most antidepressants are considered relatively safe to use during breastfeeding.
• The study 6 suggests that bupropion should not be used as a first-line agent in the pharmacological treatment of depression in pregnancy and breastfeeding due to incomplete or absent information on teratogenic and functional teratogenic risks.
• The review 7 includes bupropion as one of the antidepressants with limited information available on its use during lactation, and suggests that prescription of an antidepressant for a breast-feeding woman is a case-specific risk-benefit decision.

Key Findings

• Bupropion may not be present in significant amounts in breast milk 3.
• Potential adverse effects of bupropion on infants through breastfeeding have been reported 4.
• Bupropion is considered relatively safe to use during breastfeeding, but caution is advised due to limited information on its effects 5, 6, 7.