Is Wellbutrin (bupropion) safe during breastfeeding?

Safety of Wellbutrin (Bupropion) During Breastfeeding

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

Evidence on Bupropion Transfer to Breast Milk

Bupropion is present in human milk and has been detected in the serum of infants exposed through breastfeeding, although typically at very low or sometimes undetectable levels 1. The FDA drug label confirms that bupropion and its metabolites are present in breast milk, with infant exposure estimated at approximately 2% of the maternal weight-adjusted dose 2.

Safety Profile and Reported Adverse Events

• Generally, no adverse events have been reported in most cases of bupropion exposure during breastfeeding 1
• However, there have been two case reports of seizures in breastfed infants whose mothers were taking bupropion 1
• A more recent case report documented seizure-like symptoms in a 6.5-month-old infant exposed to both bupropion and escitalopram through breast milk 3

Risk Assessment Algorithm

1. Assess maternal need for medication

   • Is bupropion essential for maternal mental health?
   • Have alternative medications with better breastfeeding safety profiles been considered?

2. Evaluate infant risk factors

   • Premature or compromised infants may be at higher risk
   • Infants with a history of seizures should not be exposed to bupropion through breast milk

3. Consider monitoring strategies

   • Watch for vomiting, diarrhea, jitteriness, sedation, and/or seizures in the infant 1
   • Be especially vigilant during the first few weeks of exposure

Recommendations for Clinical Practice

If bupropion must be used during breastfeeding:

• Use the lowest effective dose
• Consider timing breastfeeding to avoid peak maternal drug concentrations
• Monitor the infant carefully for adverse effects, particularly neurological symptoms
• Consider measuring infant serum levels if concerns arise about potential toxicity

Alternative Approaches

When treating depression or ADHD in breastfeeding mothers, consider medications with better established safety profiles during lactation, such as:

• For depression: sertraline or paroxetine, which are considered first-line medications for postpartum depression in breastfeeding women 4
• For ADHD: methylphenidate-based medications may be safer alternatives as they have different chemical structures than bupropion 5

Important Caveats

• The risk assessment should always balance the benefits of breastfeeding against the potential risks of medication exposure 6
• The decision to use bupropion while breastfeeding should consider both maternal health needs and infant safety
• Untreated maternal depression can have significant negative impacts on infant development and maternal-infant bonding

While most breastfed infants exposed to bupropion do not experience adverse effects, the rare reports of seizures warrant caution and close monitoring if this medication is deemed necessary during lactation.