From the Guidelines
Lorazepam is present in breast milk, and nursing mothers should exercise caution when taking this medication to minimize infant exposure. The amount of lorazepam found in breast milk is typically small, but it can still potentially cause sedation, feeding difficulties, and weight loss in nursing infants 1.
Key Considerations
- Premature babies and newborns may be particularly sensitive to the effects of benzodiazepines like lorazepam due to their immature liver function and blood-brain barrier.
- If lorazepam treatment is necessary for the mother, monitoring the infant for signs of sedation, poor feeding, and weight changes is recommended.
- Short-term or occasional use may be less concerning than long-term therapy.
Minimizing Infant Exposure
- Mothers should consider taking the medication immediately after breastfeeding and waiting as long as possible before the next feeding to minimize infant exposure.
- Alternative medications with better safety profiles during lactation might be preferable when appropriate for the mother's condition, as suggested by the guideline on anaesthesia and sedation in breastfeeding women 2020 1.
Clinical Decision-Making
- The decision to use lorazepam in breastfeeding mothers should be made on a case-by-case basis, taking into account the potential benefits and risks to both the mother and the infant.
- Healthcare providers should advise women on the potential risks and benefits of lorazepam use during breastfeeding and provide guidance on how to minimize infant exposure 1.
From the FDA Drug Label
Lorazepam has been detected in human breast milk; therefore, it should not be administered to breast-feeding women, unless the expected benefit to the woman outweighs the potential risk to the infant. Lorazepam passes into your breast milk and may harm your baby. You should not breastfeed while taking lorazepam oral concentrate.
Lorazepam (Ativan) is present in breast milk. It is recommended that breastfeeding women should not take lorazepam unless the expected benefit to the woman outweighs the potential risk to the infant 2, 2, 2.
From the Research
Presence of Lorazepam in Breast Milk
- Lorazepam is detectable in breast milk, as stated in the study published in 1981 3.
- However, the maximum amounts that an infant could absorb from breast milk are considered pharmacologically insignificant, according to the same study 3.
- A more recent study from 2021 found that the milk to plasma ratio for lorazepam is less than 1, and the relative infant dose is considered safe, indicating that drug exposure through breast milk is small 4.
Safety Concerns for Breast-Feeding Infants
- The 1981 study found that full-term neonates whose mothers had received oral lorazepam had no complications apart from slight delay in establishing feeding, which was associated with relatively large doses of lorazepam 3.
- The 2021 study found no abnormalities in breastfeeding infants whose mothers were receiving lorazepam, suggesting that maternal drug treatment and breastfeeding are compatible 4.
- Other studies have emphasized the importance of considering the benefits of breastfeeding and the risks of untreated maternal disease when assessing the safety of drugs during breastfeeding 5, 6, 7.
General Guidance on Medication Use During Breastfeeding
- Most drugs are transferred from the mother's blood to the milk, but the breastfed infant usually ingests a small amount of the drug through human milk, as noted in the 2023 study 6.
- Healthcare providers should assume that mothers will be concerned about medication use during breastfeeding and use risk communication to ensure medication adherence and prevent unnecessary interruption of breastfeeding, as recommended in the 2023 study 6.