Is it safe to take Nurtec (rimegepant) while breastfeeding?

Safety of Nurtec (Rimegepant) During Breastfeeding

Nurtec (rimegepant) can be safely taken while breastfeeding as the medication passes into breast milk in very small amounts with minimal risk to the breastfed infant. According to the FDA drug label, a lactation study has established that the relative infant dose is less than 1% of the maternal weight-adjusted dose with a milk-to-plasma ratio of only 0.20 1.

Evidence on Rimegepant in Breastfeeding

The FDA drug label for Nurtec ODT (rimegepant) provides the most definitive information regarding its use during breastfeeding:

• A specific lactation study was conducted with twelve healthy lactating women who were between 2 weeks and 6 months postpartum
• After administration of a single 75 mg dose of rimegepant:
  • The relative infant dose was determined to be less than 1% of the maternal weight-adjusted dose
  • The average milk-to-plasma ratio was only 0.20 1

This data confirms that transfer of rimegepant into breast milk is low, suggesting minimal exposure to the breastfed infant.

Clinical Decision-Making Framework

When considering Nurtec while breastfeeding:

1. Benefit-Risk Assessment:

   • The very low transfer of rimegepant into breast milk (less than 1% relative infant dose) indicates minimal risk to the infant
   • Untreated migraine can significantly impact maternal functioning and quality of life
   • The FDA label states: "The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for NURTEC ODT" 1

2. Monitoring Recommendations:

   • No specific monitoring of the infant is required based on the available data
   • As with any medication, observe the infant for any unusual symptoms
   • Unlike many other medications used for migraine (such as certain opioids), there are no warnings about sedation or respiratory depression in breastfed infants

Important Considerations

• The FDA has established a pregnancy registry for women taking Nurtec during pregnancy, but no special precautions are indicated for breastfeeding beyond the information provided 1
• Unlike some other migraine medications that require caution or are contraindicated during breastfeeding (such as ergotamine, high-dose ASA, or certain anticonvulsants) 2, rimegepant has specific lactation data supporting its safety

Practical Advice

• You can take Nurtec ODT while breastfeeding without needing to interrupt breastfeeding
• No "pump and dump" period is necessary due to the minimal transfer into breast milk
• If you have concerns about potential side effects in your infant, you can time the medication dose to be just after a feeding to minimize exposure

This guidance is based on specific pharmacokinetic data from the FDA drug label, which provides the most reliable and recent evidence regarding the safety of Nurtec during breastfeeding.