Is Wellbutrin (bupropion) safe for breastfeeding mothers?

Bupropion (Wellbutrin) Safety During Breastfeeding

Caution is advised when using bupropion (Wellbutrin) during breastfeeding due to limited data and rare reports of seizures in breastfed infants. 1

Evidence Summary

Bupropion passes into breast milk and has been detected in the serum of breastfed infants, although typically at very low or sometimes undetectable levels 1, 2. The current evidence regarding safety shows:

• Very limited data exists (only about 21 documented cases) 1
• Bupropion concentrates in breast milk at levels higher than maternal plasma (milk-to-plasma ratios ranging from 2.51 to 8.58) 3
• Generally, no adverse events have been reported in most cases 1
• However, there have been two case reports of seizures in breastfed infants exposed to bupropion through breast milk 1, 4

Risk Assessment

The risk profile for bupropion during breastfeeding includes:

1. Infant exposure: The average daily infant exposure to bupropion and its active metabolites is approximately 2% of the maternal weight-adjusted dose 2

2. Serious concerns:

   • Two documented cases of seizure-like symptoms in breastfed infants 1, 4
   • One case report specifically documented seizure-like symptoms in a 6.5-month-old infant exposed to both bupropion and escitalopram through breast milk 4

3. Detection in infant serum:

   • In some cases, bupropion and its active metabolite hydroxybupropion have been detected in infant serum 4
   • Other studies have found no quantifiable levels in infant serum 5

Recommendations for Clinical Practice

1. Alternative medications:

   • If antidepressant treatment is needed during breastfeeding, consider SSRIs like sertraline or paroxetine as first-line options, which have better safety profiles during lactation 6

2. If bupropion is necessary:

   • Use the lowest effective dose
   • Consider timing breastfeeding to avoid peak drug concentrations (typically 2 hours after dosing) 3
   • Monitor the infant carefully for:
     • Vomiting
     • Diarrhea
     • Jitteriness
     • Sedation
     • Seizures or seizure-like activity 1

3. Risk mitigation strategies:

   • Consider partial formula supplementation during periods of highest drug concentration
   • If adverse effects are observed, evaluate whether reducing the dose or replacing some breastfeedings with formula might help 7

Important Considerations

• The benefits of breastfeeding and treating maternal depression must be weighed against the potential risks of medication exposure
• Untreated maternal depression can have significant negative impacts on infant development and maternal-infant bonding
• The decision should consider the severity of maternal depression, response to previous treatments, and availability of alternative medications with better safety profiles during lactation

Remember that while most infants exposed to bupropion through breast milk experience no adverse effects, the rare but serious risk of seizures warrants careful monitoring and consideration of alternatives when possible.