Is it safe to breastfeed while taking Vyvanse (lisdexamfetamine)?

Breastfeeding While Taking Vyvanse (Lisdexamfetamine)

Breastfeeding is not recommended during treatment with Vyvanse (lisdexamfetamine) due to the risk of serious adverse reactions in nursing infants, including cardiovascular effects, growth suppression, and potential neurodevelopmental impacts. 1

Risks of Lisdexamfetamine During Breastfeeding

Lisdexamfetamine is a prodrug that converts to dextroamphetamine in the body. According to the FDA drug label, amphetamines pass into breast milk with the following concerns:

• Present in human milk at relative infant doses of 2% to 13.8% of the maternal weight-adjusted dosage 1
• Milk/plasma ratio ranges between 1.9 and 7.5 1
• Potential serious adverse reactions in nursing infants include:
  • Cardiovascular reactions
  • Blood pressure and heart rate increases
  • Suppression of growth
  • Peripheral vasculopathy 1

Additionally, large doses of dextroamphetamine might interfere with milk production, especially in women whose lactation is not well established 1.

Long-term Considerations

The FDA label specifically notes that "long-term neurodevelopmental effects on infants from amphetamine exposure are unknown" 1. Animal studies have shown that prenatal or early postnatal exposure to amphetamine at doses similar to those used clinically can result in long-term neurochemical and behavioral alterations, including:

• Learning and memory deficits
• Altered locomotor activity
• Changes in sexual function 1

Clinical Guidance

The American Academy of Pediatrics notes that while methylphenidate and bupropion can be maintained during breastfeeding, amphetamine derivatives (like lisdexamfetamine) require special consideration 2. When amphetamine derivatives are used, discussions about breastfeeding safety should occur, and consideration should be given to timing feedings to achieve the lowest concentration in milk 2.

Alternative Approaches

For mothers with ADHD who wish to breastfeed, consider these alternatives:

1. Methylphenidate-based medications: These may be safer options during breastfeeding according to the American Academy of Pediatrics 2

2. Non-stimulant medications: Consider medications like atomoxetine or alpha-2 agonists that might have different risk profiles during lactation 2

3. Behavioral interventions: Evidence-based training interventions such as Dialectical Behavior Therapy (DBT) and Mindfulness-Based Interventions (MBIs) can be helpful adjuncts or alternatives 2

Important Considerations When Medication Is Necessary

If a mother must take lisdexamfetamine while breastfeeding due to severe ADHD symptoms:

• Use the lowest effective dose
• Time medication administration to minimize infant exposure (typically right after breastfeeding and before the infant's longest sleep period) 3
• Monitor the infant closely for:
  • Changes in sleep patterns
  • Decreased appetite
  • Irritability
  • Poor weight gain
  • Cardiovascular symptoms

Bottom Line

The FDA drug label clearly advises against breastfeeding while taking lisdexamfetamine due to potential serious risks to the infant 1. If treatment for ADHD is necessary during the breastfeeding period, methylphenidate-based medications may offer a safer alternative 2, though all medication decisions should prioritize both maternal mental health and infant safety.